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Increased plasma levels of high density lipoproteins
6%
85/1411
Decreased systolic and diastolic blood pressure
2%
23/1411
Increased plasma levels of low density lipoproteins
77%
1092/1411
Alteration of myocardial conduction patterns
79/1411
Direct endothelial damage to coronary arteries
9%
126/1411
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Heart disease in an otherwise healthy young athlete who is abusing anabolic steroids likely results from increased levels of low-density lipoprotein (LDL) and decreased levels of high-density lipoprotein (HDL). Several studies suggest that anabolic steroid abuse in athletes increases LDL levels by >20% and decreases HDL levels by 20% to 70%. These lipoprotein abnormalities have been shown to increase the risk for coronary artery disease three- to six-fold. Anabolic steroid abuse may cause cardiac ischemia by exaggerating oxygen demand at peak exercise, potentially precipitated by accelerated atherosclerosis from lipoprotein abnormalities over years of abuse. Silver reviewed the adverse effects of anabolic steroids in a JAAOS article and reported that anabolic steroid use can lead to hypertension, changes in lipid profile, elevated liver enzymes, increased risk of tendon and muscle injury, testicular or uterine atrophy, depression, psychosis, and immunosuppression. Achar et al. reviewed a total of 49 studies describing 1,467 athletes to investigate the cardiovascular effects of the anabolic steroid abuse. They found that anabolic steroid abuse was associated with elevated levels of LDL, low levels of HDL, elevated systolic and diastolic blood pressure, and left ventricular hypertrophy. They also noted that there were some small case studies describing fatal ventricular arrhythmias secondary to anabolic steroid abuse. Incorrect Answers: Answer 1: High density lipoprotein levels are decreased, not increased, in those abusing anabolic steroids. This decrease in HDL levels contributea to the development of heart disease in these otherwise healthy individuals. Answer 2: Systolic and diastolic blood pressure are elevated, not decreased, after prolonged anabolic steroid use. This does not lead to heart disease in those who abuse anabolic steroids. Answer 4: Alteration of myocardial conduction patterns (i.e., ventricular arrhythmia) is not a cause of heart disease in anabolic steroid abusers. It is, however, a cause of sudden death in these individuals. Answer 5: Anabolic steroids do not cause 'direct' endothelial damage to the coronary arteries.
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