Cardiovascular Toxicities of Performance-Enhancing Substances in Sports

Cardiovascular Toxicities of Performance-Enhancing Substances in Sports / Ritesh Dhar, C. William Stout, Mark S. Link, Munther K. Homoud, Jonathan Weinstock, N.A. Mark Estes 3rd. - (Mayo Clinic Proceedings 80 (2005) 10 (1 October); p. 1307-1315.

  • PMID: 16212144 
  • DOI: 10.4065/80.10.1307 


Athletes commonly use drugs and dietary supplements to improve athletic performance or to assist with weight loss. Some of these substances are obtainable by prescription or by illegal means; others are marketed as supplements, vitamins, or minerals. Nutritional supplements are protected from Food and Drug Administration regulation by the 1994 US Dietary Supplement Health and Education Act, and manufacturers are not required to demonstrate proof of efficacy or safety. Furthermore, the Food and Drug Administration lacks a regulatory body to evaluate such products for purity. Existing scientific data, which consist of case reports and clinical observations, describe serious cardiovascular adverse effects from use of performance-enhancing substances, including sudden death. Although mounting evidence led to the recent ban of ephedra (ma huang), other performance-enhancing substances continue to be used frequently at all levels, from elementary school children to professional athletes. Thus, although the potential for cardiovascular injury is great, few appropriately designed studies have been conducted to assess the benefits and risks of using performance-enhancing substances. We performed an exhaustive OVID MEDLINE search to Identify all existing scientific data, review articles, case reports, and clinical observations that address this subject. In this review, we examine the current evidence regarding cardiovascular risk for persons using anabolic-androgenic steroids including 2 synthetic substances, tetrahydrogestrinone and androstenedione (andro), stimulants such as ephedra, and nonsteroidal agents such as recombinant human erythropoietin, human growth hormone, creatine, and beta-hydroxy-beta-methylbutyrate.

Original document


1 October 2005
Dhar, Ritesh
Estes III, Mark
Homoud, Munther K.
Link, Mark S.
Stout, C. William
Weinstock, Jonathan
United States of America
Other organisations
Tufts University School of Medicine
Doping classes
S1. Anabolic Agents
S2. Peptide Hormones, Growth Factors
S6. Stimulants
1-Androstenedione (5α-androst-1-ene-3, 17-dione)
Erythropoietin (EPO)
Growth hormone (GH)
Insulin-like Growth Factor-1 (IGF-1)
Tetrahydrogestrinone (THG) (17-hydroxy-18a-homo-19-nor-17α-pregna-4,9,11-trien-3-one)
Medical terms
Cardiovascular diseases
Health effects
Document category
Scientific article
Document type
Pdf file
Date generated
21 July 2020
Date of last modification
16 September 2020
  • Legal Source
  • Education
  • Science
  • Statistics
  • History
Country & language
  • Country
  • Language
Other filters
  • ADRV
  • Legal Terms
  • Sport/IFs
  • Other organisations
  • Laboratories
  • Analytical aspects
  • Doping classes
  • Substances
  • Medical terms
  • Various
  • Version
  • Document category
  • Document type
Publication period