- Design
- Systematic review and random-effects meta-analysis of observational studies
- Population
- 15 reports; mortality pooled from 3 cohorts of steroid-exposed people
- Primary outcome
- All-cause mortality
- Effect
- RR 2.57 (95% CI 1.98–3.33), I² 0%
A systematic review pooled 15 reports on non-medical anabolic-androgenic steroid use. Across three comparative cohorts, exposure was associated with higher all-cause mortality (RR 2.57, 95% CI 1.98–3.33, I² 0%), although the prediction interval was very wide (0.47–13.87). In one large matched cohort, adjusted hazard ratios for cardiovascular outcomes ranged from 2.26 to 8.90, highest for cardiomyopathy. Former users had slightly worse global longitudinal strain than non-users.
The evidence base is small and observational, so steroid use may mark other risks, such as other drug use. Even so, the signal is consistent, and many users never mention it unless asked.
In a young man with unexplained cardiomyopathy, hypertension, erythrocytosis or a low HDL, ask directly about steroid use, including past use.
- Ask about current and past anabolic steroid use in young men with cardiomyopathy or unexplained hypertension.
- Check haematocrit, lipids and blood pressure in known users.
- Consider echocardiography with strain in former heavy users who have symptoms.
- Frame the question without judgement; users often disclose only when asked plainly.
Why it matters
Steroid use is a cardiovascular risk factor that rarely appears in the history unless someone asks.
Don't overread it
These were three observational cohorts; residual confounding means the steroids themselves may not account for all of the excess deaths.
The statistics, in plain English
An RR of 2.57 means about two and a half times the death rate. I² of 0% means the three cohorts agreed, but the prediction interval crossing 1.0 shows a new setting could look quite different.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for cardiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free