Anabolic-androgenic steroids (AAS) are synthetic substances related to testosterone. Some people use them without medical supervision to increase muscle size, strength, or athletic performance.
Although these drugs can produce physical changes, research has raised important concerns about their effects on cardiovascular health. Recent studies have found associations between non-medical AAS use and several cardiovascular problems, including heart attacks, abnormal heart rhythms, blood clots, cardiomyopathy, and heart failure.
What Are Anabolic Steroids?
Anabolic-androgenic steroids are synthetic versions or derivatives of hormones related to testosterone.
They are different from corticosteroids, which are commonly prescribed to reduce inflammation.
When anabolic steroids are used without appropriate medical supervision, doses and patterns of use may differ substantially from therapeutic medical use. This distinction is important when interpreting research about their risks.
What Did the Recent Danish Study Find?
A 2025 study published in Circulation examined cardiovascular outcomes among 1,189 men who had been sanctioned for anabolic-androgenic steroid use at Danish fitness centers.
Researchers compared them with 59,450 men from the general population who were matched by age and sex. Participants were followed for an average of about 11 years.
The researchers found that AAS users had higher rates of several cardiovascular outcomes.
For acute myocardial infarction, commonly called a heart attack, the adjusted hazard ratio was 3.00.
The study also reported higher rates of coronary procedures, venous blood clots, arrhythmias, cardiomyopathy, and heart failure among AAS users.
What Does “Three Times the Risk” Actually Mean?
The phrase “three times the risk” can easily be misunderstood.
The study reported an adjusted hazard ratio of 3.00 for acute myocardial infarction. This means the rate of heart attacks during the study period was estimated to be about three times higher among the AAS group than among the matched comparison group after statistical adjustment.
It does not mean that three out of every three steroid users will have a heart attack.
It also does not establish that anabolic steroids were the only cause of the cardiovascular events. Because this was an observational study, researchers can identify an association but cannot prove causation in the same way as a randomized clinical trial.
Why Might Anabolic Steroids Affect the Heart?
Several biological mechanisms may contribute to cardiovascular risk.
Research and public-health information have linked anabolic steroid use with changes in cholesterol, increased blood pressure, changes in heart structure and function, and increased tendency toward blood clot formation. These effects can contribute to cardiovascular disease.
The heart itself may also be affected. The 2025 Danish study found associations between AAS exposure and cardiomyopathy and heart failure.
What About Long-Term Steroid Use?
Duration of exposure may matter.
A separate 2025 study of recreational athletes found that greater cumulative lifetime AAS exposure was associated with several adverse cardiovascular findings, including coronary plaque and changes in heart muscle function. Participants with longer exposure also showed more pronounced cardiovascular abnormalities.
However, this was a relatively small cross-sectional study, so the findings should be interpreted alongside other research rather than viewed as proof that a specific duration of steroid use will produce a particular outcome.
Are These Risks Limited to Older Adults?
No.
Cardiovascular concerns related to anabolic steroids are not limited to older people. NIDA notes that anabolic steroid use has been associated with cardiovascular problems including heart attacks and strokes, as well as changes in cholesterol and heart function.
This is particularly important because some people who use these drugs recreationally are young and may otherwise consider themselves healthy.
What About People Who Use Steroids for Medical Reasons?
This article is primarily discussing non-medical or illicit use of anabolic-androgenic steroids.
Medical treatment involving testosterone or other hormone-related medicines is a separate issue. The risks and benefits depend on the specific medicine, dose, reason for treatment, medical history, and clinical monitoring.
Anyone taking a prescribed hormone medication should discuss concerns with the healthcare professional who prescribed it rather than stopping treatment independently.
What Should People Know Before Using Anabolic Steroids?
Anabolic steroids are not risk-free muscle-building supplements.
People considering non-medical AAS use should understand that cardiovascular effects are one of several potential health concerns. Other possible problems can involve hormone production, reproductive health, liver function, mood, and other body systems.
The safest way to address concerns about steroid use is to speak with a qualified healthcare professional.
When Should Someone Seek Medical Attention?
Anyone experiencing possible symptoms of a heart attack or another serious cardiovascular problem should seek emergency medical care.
Symptoms such as chest pressure or pain, severe shortness of breath, fainting, or sudden unexplained weakness should not be ignored.
If you are using anabolic steroids and are concerned about blood pressure, cholesterol, heart symptoms, or other health effects, discuss those concerns with a healthcare professional.
The Bottom Line
Research increasingly links non-medical anabolic-androgenic steroid use with cardiovascular problems.
A 2025 Danish cohort study found a substantially higher rate of acute myocardial infarction among men who had used AAS, with an adjusted hazard ratio of 3.00. The same study also found higher rates of several other cardiovascular outcomes.
The findings are important, but they should be reported accurately. A “threefold” hazard ratio is not the same as saying every steroid user will have a heart attack.
Anabolic steroids can carry serious health risks, and anyone considering or currently using them should discuss the potential consequences with a qualified healthcare professional.
Medical Disclaimer
This article is for general educational purposes only and does not provide individualized medical advice, diagnosis, or treatment. If you use anabolic steroids or have concerns about your cardiovascular health, speak with a qualified healthcare professional.
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