Anabolic steroids, acute myocardial infarction and polycythemia: A case report and review of the literature

Case report

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Authors: Kathleen Stergiopoulos, Joseph J Brennan, Robin Mathews, John F Setaro, Smadar Kort

Published Date November 2008 Volume 2008:4(6) Pages 1475 - 1480

DOI: http://dx.doi.org/10.2147/VHRM.S4261

Kathleen Stergiopoulos¹, Joseph J Brennan², Robin Mathews¹, John F Setaro², Smadar Kort¹

¹Division of Cardiovascular Medicine, Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA; ²Division of Cardiovascular Medicine, Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT, USA

Abstract: The association between testosterone-replacement therapy and cardiovascular risk remains unclear with most reports suggesting a neutral or possibly beneficial effect of the hormone in men and women. However, several cardiovascular complications including hypertension, cardiomyopathy, stroke, pulmonary embolism, fatal and nonfatal arrhythmias, and myocardial infarction have been reported with supraphysiologic doses of anabolic steroids. We report a case of an acute ST-segment elevation myocardial infarction in a patient with traditional cardiac risk factors using supraphysiologic doses of supplemental, intramuscular testosterone. In addition, this patient also had polycythemia, likely secondary to high-dose testosterone. The patient underwent successful percutaneous intervention of the right coronary artery. Phlebotomy was used to treat the polycythemia acutely. We suggest that the chronic and recent “stacked” use of intramuscular testosterone as well as the resultant polycythemia and likely increased plasma viscosity may have been contributing factors to this cardiovascular event, in addition to traditional coronary risk factors. Physicians and patients should be aware of the clinical consequences of anabolic steroid abuse.

Keywords: acute myocardial infarction, anabolic steroid use, polycythemia