HEART FAILURE SECONDARY TO ANABOLIC-ANDROGENIC STEROID USE IN YOUNG ADULTS: MECHANISMS, DIAGNOSIS AND CLINICAL IMPLICATIONS

Abstract

Introduction: Non-medical use of anabolic-androgenic steroids by young adults has been associated with ventricular hypertrophy, systolic and diastolic dysfunction, arrhythmias, premature atherosclerosis, dilated cardiomyopathy and heart failure. The condition is underdiagnosed because many users do not spontaneously disclose exposure and athletic appearance may lower clinical suspicion. Objective: To revise and deepen the review on heart failure secondary to anabolic-androgenic steroid use in young adults, emphasizing pathophysiological mechanisms, clinical findings, differential diagnosis and management. Methodology: A rapid qualitative systematic review guided by PRISMA 2020 was conducted in PubMed, BVS and SciELO between 2021 and 2026, supplemented by heart failure guidelines and key reviews. Results: Recent studies show associations between cumulative anabolic steroid exposure and increased ventricular mass, impaired strain, reduced ejection fraction, biventricular cardiomyopathy, arrhythmias, increased heart failure risk and cardiovascular events. Conclusion: In young adults with nonischemic cardiomyopathy, unexplained hypertrophy, arrhythmias or heart failure, anabolic steroid use should be actively and confidentially investigated without stigmatization.