Testosterone, sex hormone-binding globulin, lipoproteins, and vascular disease risk.

BACKGROUND

That men have a higher risk of coronary heart disease has implicated testosterone as a risk factor. Lipoprotein levels have been reported to be altered by androgens, thus increasing the risk of coronary heart disease, myocardial infarction, and sudden death. The increasing abuse of anabolic steroids and reports of cases of sudden death and myocardial infarction among bodybuilders have raised concerns about an increase in cardiovascular risk for this population.

METHODS

Twelve competitive bodybuilders were recruited for a comprehensive study on the cardiovascular risks associated with use of anabolic steroids. Six competitive heavyweight bodybuilders ingesting self-directed regimens of anabolic steroids (steroid group) and six competitive heavyweight drug-free bodybuilders were used for cardiovascular risk assessment. Apolipoproteins A-I and B, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglyceride, testosterone, and sex hormone-binding globulin levels were determined in each athlete.

RESULTS

Total, HDL and LDL cholesterol, apolipoproteins A-I and B, and triglyceride levels were significantly lower in members of the steroid group. As expected, testosterone level was significantly higher in members of the steroid group; sex hormone-binding globulin level was significantly lower. Apolipoprotein and lipoprotein levels were lower in members of the steroid group, whereas the total: HDL cholesterol ratio was significantly higher for members of the steroid group.

CONCLUSIONS

Consistently with previous reports, androgens were associated with decreases in HDL cholesterol and apolipoprotein A-I levels. However, androgens were also associated with reduced LDL cholesterol and apolipoprotein B levels. Despite the significantly higher total: HDL cholesterol ratio, the low serum total cholesterol levels (within the fifth percentile) and low plasma triglyceride levels in members of the steroid group raise questions concerning the exact role of androgens in increasing risk of cardiovascular disease.