The Cardiac Effects of Performance-Enhancing Medications: Caffeine vs. Anabolic Androgenic Steroids

The Cardiac Effects of Performance-Enhancing Medications: Caffeine vs. Anabolic Androgenic Steroids / Sanjay Sivalokanathan, Łukasz A. Małek, Aneil Malhotra. - (Diagnostics 11 (2021) 2 (17 February); p. 1-14)

  • PMID: 33671206
  • PMCID: PMC7922604
  • DOI: 10.3390/diagnostics11020324


Several performance-enhancing or ergogenic drugs have been linked to both significant adverse cardiovascular effects and increased cardiovascular risk. Even with increased scrutiny on the governance of performance-enhancing drugs (PEDs) in professional sport and heightened awareness of the associated cardiovascular risk, there are some who are prepared to risk their use to gain competitive advantage. Caffeine is the most commonly consumed drug in the world and its ergogenic properties have been reported for decades. Thus, the removal of caffeine from the World Anti-Doping Agency (WADA) list of banned substances, in 2004, has naturally led to an exponential rise in its use amongst athletes. The response to caffeine is complex and influenced by both genetic and environmental factors. Whilst the evidence may be equivocal, the ability of an athlete to train longer or at a greater power output cannot be overlooked. Furthermore, its impact on the myocardium remains unanswered. In contrast, anabolic androgenic steroids are recognised PEDs that improve athletic performance, increase muscle growth and suppress fatigue. Their use, however, comes at a cost, afflicting the individual with several side effects, including those that are detrimental to the cardiovascular system. This review addresses the effects of the two commonest PEDs, one legal, the other prohibited, and their respective effects on the heart, as well as the challenge in defining its long-term implications.

Original document


17 February 2021
Małek, Łukasz A.
Sivalokanathan, Sanjay
United Kingdom
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Narodowy Instytut Kardiologii Stefana kardynała Wyszyńskiego - Cardinal Wyszynski National Institute of Cardiology
St George's, University of London (SGUL)
University of Manchester
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S1. Anabolic Agents
S6. Stimulants
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Health effects
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Scientific article
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18 March 2021
Date of last modification
20 March 2021
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