Adverse cardiovascular effects of anabolic steroids: pathophysiology imaging Reza Golestani*, Riemer H. J. A. Slart*, Robin P. F. Dullaart † , Andor W. J. M. Glaudemans * , Clark J. Zeebregts ‡ , Hendrikus H. Boersma *,§ , Rene ´ A. Tio ¶ and Rudi A. J. O. Dierckx *,** Departments of *Nuclear Medicine and Molecular Imaging, † Endocrinology, ‡ Division of Vascular Surgery, Department of Surgery, Departments of § Clinical Pharmacy and ¶ Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands, **Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium ABSTRACT Background Anabolic-androgenic steroids (AAS) are widely abused for enhancing muscle mass, strength, growth and improving athletic performance. Materials and methods In recent years, many observational and interventional studies have shown important adverse cardiovascular effects of AAS abuse. Conclusions This review discusses established and future perspectives of novel molecular imaging techniques that may serve as potential tools for early detection of AAS-associated cardiovascular disorders. Keywords Anabolic-androgenic steroids, cardiovascular, imaging, molecular imaging. Eur J Clin Invest 2012 Introduction The term ‘anabolic-androgenic steroids (AAS)’ refers to a group of compounds that are structurally related to testosterone and exert two main physiological effects including muscle growth and masculinization [1]. Since 1940s, AAS therapy has been advocated as substitution therapy of testosterone deficiency and hypogonadism [1]. Moreover, AAS in high doses has been abused with the purpose to enhance muscle mass and improve athletic performance. AAS administration has been shown to be associated with cardiovascular side effects [2], urogenital problems, that is, gynecomastia, impotency [1], hepatotoxicity [3], hepatocellu- lar carcinoma [4] and neuropsychiatric disorders, that is, aggressiveness and depression [5]. Cardiovascular adverse effects of AAS abuse have been reported sporadically as case reports of hypertension [6], myocardial infarction (MI) and stroke [6], dysrhythmia [7], cardiomyopathy [8], and sudden cardiac death [9] in body builders with long-term AAS abuse in the recent years. Case reports on hard atherosclerotic end- points (sudden cardiac death, MI or stroke) comprise young AAS abusers without preexistent cardiac risk factors, suggest- ing that a high AAS dose imposes additional independent risk to conventional cardiovascular risk factors. Parssinen et al. [10] reported a more than four times higher incidence of early death in professional athletes abusing AAS compared to the age- and sex-matched general population, in a 12-years prospective observation. In addition to the potential risk associated with AAS abuse, it is notable that therapeutic treatment with AAS in hypogonadic men has recently been shown to be linked with a higher cardio- vascular event rate [11]. This important finding underscores that there is a delicate balance between benefits and risks related to AAS use as a treatment option for patients suffering from androgen deficiency. Adding up clinical AAS use and ille- gal AAS abuse rates represent a new wave of AAS-associated cardiovascular adverse consequences, in which early diagnosis can reduce health burden. Molecular imaging is a promising method to target and image certain biomarkers in the process of cardiovascular pathology that can be used for early detection of AAS-associ- ated adverse effects. A number of modalities and tracers are currently being developed that may become useful to delineate functional abnormalities in several pathways involved in AAS- induced cardiovascular injury at the preclinical and clinical level [12,13]. In this study, we review previous literature on cardiovascu- lar side effects associated with AAS (ab)use and promising European Journal of Clinical Investigation 1 DOI: 10.1111/j.1365-2362.2011.02642.x REVIEW