ST-Elevation Myocardial Infarction in Patient with Anabolic Steroid Abuse

Background: The use and abuse of anabolic steroids for performance enhancement in athletes and bodybuilders, both professional and amateur, is well documented; however, the short and long term implications of this practice on the cardiovascular system are not well defined.
Case: 34 year old amateur bodybuilder with 10 year history of self-administered testosterone injection who presented with chest pain. Patient was found to have acute coronary syndrome due to near complete occlusion of LAD. The patient underwent placement of DES to LAD with resolution of symptoms.
Conclusions: Presentation of acute coronary syndrome in young patients without traditional risk factors for coronary artery disease should prompt investigation for atypical risk factors including anabolic steroid abuse. The mechanism for these events may be related to accelerated thrombosis in setting of elevated pre-disposition to hyperlipidemia and dysregulation of the thrombosis cascade. In addition, patient with traditional risk factors for coronary artery disease may be at risk for acute coronary thrombotic events at a younger age and more pronounced in terms of severity of events in setting of anabolic steroid abuse.