Coronary Calcification in Bodybuilders Using Anabolic Steroids

Lawrence J. Santora, MD, FACC, Jairo Marin, MD, FACC, Jack Vangrow, MD, Craig Minegar, RDCS, Mary Robinson, NP, Janet Mora, RT, Gerald Friede.

We measured coronary artery calcification as a means of examining the impact of anabolic steroids on the development of atherosclerotic disease in bodybuilders using anabolic steroids over an extended period of time. 14 male professional body builders with no history of cardiovascular disease were evaluated for coronary artery calcium, serum lipids, left ventricular function, and exercise induced myocardial ischemia. 7 subjects had coronary artery calcium, with a much higher than expected mean score of 98, six of the seven calcium scores were >90th percentile. Mean total cholesterol was 192 ml/dl, while mean HDL was 23/ml/dl and the mean ratio of total cholesterol/HDL was 8.3. Left ventricular ejection fraction ranged between 49% and 68%, with a mean of 59%. No subject had evidence of myocardial ischemia. This small group of professional bodybuilders with a long history of steroid abuse had high levels of coronary artery calcium for age. We conclude that in this small pilot study there is an association of early coronary artery calcium in long term steroid abusers. Further large-scale studies are warranted.

Orange County, California

From The Orange County Heart Institute and Research Center, Orange, California, and OC Vital Imaging, Orange, California.

Special thanks to Mark Nalley for his invaluable help in identifying the subjects and arranging for their participation in this study.

The following studies are the strongest and most compelling evidence that coronary calcium scans using the EBCT scanner is the most important predictor of future cardiac events (a cardiac event is a heart attack, sudden cardiac death, or the need for coronary bypass surgery or angioplasty or stents). Traditionally, doctors have used the Framingham Risk Factors such as high cholesterol, hypertension, diabetes, obesity, tobacco use and family history of heart disease to determine how to treat a patient and determine the risk of heart disease. These risk factors, though very helpful, a extremely less accurate than coronary calcium screening.

Coronary artery calcium score and coronary heart disease events in a large cohort of asymptomatic men and women.

LaMonte MJ, FitzGerald SJ, Church TS, Barlow CE, Radford NB, Levine BD, Pippin JJ, Gibbons LW, Blair SN, Nichaman MZ.

Centers for Integrated Health Research, The Cooper Institute, Dallas, TX 75230, USA. mlamonte@cooperinst.org

Coronary artery calcium (CAC), a measure of subclinical coronary heart disease (CHD), may be useful in identifying asymptomatic persons at risk of CHD events. The current study included 10,746 adults who were 22-96 years of age, were free of known CHD, and had their CAC quantified by electron-beam tomography at baseline as part of a preventive medical examination at the Cooper Clinic (Dallas, Texas) during 1995-2000. During a mean follow-up of 3.5 years, 81 hard events (CHD death, nonfatal myocardial infarction) and 287 total events (hard events plus coronary revascularization) occurred. Age-adjusted rates (per 1,000 person-years) of hard events were computed according to four CAC categories: no detectable CAC and incremental sex-specific thirds of detectable CAC; these rates were, respectively, 0.4, 1.5, 4.8, and 8.7 (trend p<0.0001) for men and 0.7, 2.3, 3.1, and 6.3 (trend p=0.02) for women. CAC levels also were positively associated with rates of total CHD events for women and men (trend p<0.0001 each). The association between CAC and CHD events remained significant after adjustment for CHD risk factors. CAC was associated with CHD events in persons with no baseline CHD risk factors and in younger (aged <40 years) and older (aged >65 years) study participants. These findings show that CAC is associated with an increased risk of CHD events in asymptomatic women and men.

CLINICAL RESEARCH: IMAGING

Detection of High-Risk Young Adults and Women by Coronary Calcium and National Cholesterol Education Program Panel III Guidelines

Khurram Nasir, MD, MPH.^1,2, Erin D. Michos, MD², Roger S. Blumenthal, MD² and Paolo Raggi, MD^1,3

1. Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
2. The Ciccarone Preventive Cardiology Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
3. Section of Cardiology, Tulane University, New Orleans, Louisiana

Manuscript received May 10, 2005; revised manuscript received July 1, 2005, accepted July 19, 2005.

Reprint requests and correspondence: Dr. Paolo Raggi, 1430 Tulane Avenue, SL-48, New Orleans, Louisiana 70112 (Email: praggi@excite.com).

BACKGROUND: Current NCEP guidelines might underestimate cardiovascular risk in young individuals and women.

METHODS: The study population consisted of 1,611 asymptomatic individu al s(67% men, mean age: 53 ± 10 years) who presented to a single electron beam tomography facility for coronary artery calcium screening. Participants were categorized into low-risk (n = 738, 46%), intermediate-risk (n = 583, 36%), moderately high-risk (n = 263, 16%), and high-risk (n = 27, 2%) according to the NCEP Panel III guidelines.

RESULTS: Absence of calcium, CCS of 0 to 99 (mild), 100 to 399 (moderate), and >400 (severe), was observed in 572 (35%), 707 (44%), 192 (12%), and 140 (9%) of the patients, respectively. A high CCS percentile (>75th percentile) was present in 426 (26%) individuals. Overall, 59% and 78% of participants with CCS >400 and CCS >75th percentile were not identified as high risk and candidates for pharmacotherapy on the basis of NCEP categories. Furthermore, women as well as young individuals were less likely to be considered candidates for pharmacotherapy compared with men and older individuals in each CCS category.

CONCLUSIONS: The NCEP guidelines seem to underestimate cardiovascular risk in young asymptomatic individuals and women. For these individuals, assessment of plaque burden might provide incremental value to global risk assessment.