madman
Super Moderator
ABSTRACT
Aims
The cardiovascular risks associated with anabolic-androgenic steroid (AAS) use, particularly nandrolone decanoate (ND), remain a topic of debate due to conflicting evidence from different types of studies. While observational research frequently reports adverse cardiac effects, findings from randomized controlled trials (RCTs) suggest otherwise. This review aims to critically assess the available RCTs evaluating the impact of ND on cardiac morphology and function, with a focus on their methodological quality and clinical relevance.Study Design: Structured review of randomized controlled trials.
Methods
A systematic literature search was conducted to identify RCTs that examined the effects of ND on cardiac function. The analysis included study design, sample size, inclusion/exclusion criteria, cardiac evaluation methods, and reported outcomes. The methodological quality of each study was assessed using the Jadad scale to ensure a rigorous evaluation of the evidence.
Results
The two reviewed RCTs, which were of moderate to high methodological quality, did not report clinically significant cardiac dysfunction in healthy individuals after short-term exposure toND. However, these findings contrast with several observational studies, where users—often exposed to uncontrolled conditions and higher doses—frequently present with structural and functional cardiac changes. A key limitation of the RCTs was their small sample sizes, short follow up durations, and reliance on conventional imaging techniques, which may not be sensitive enough to detect subtle cardiac alterations.
Conclusion
While current RCTs do not provide strong evidence of cardiovascular harm from ND,their methodological limitations underscore the need for further research. Future trials with larger sample sizes, higher statistical power, and more advanced cardiac imaging techniques will be crucial in clarifying the true impact of ND on the heart. Until more definitive data are available,routine cardiac monitoring should be considered for individuals using ND, particularly those on prolonged or high-dose regimens.
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5. CONCLUSION
The available RCTs, conducted with moderate to high methodological quality, did not demonstrate clinically significant adverse effects on cardiac morphology or function in young, healthy individuals following short-term administration of ND (Hartgens et al., 2003; Chung et al., 2007). However, these findings contrast with those from observational studies, which frequently report deleterious cardiovascular changes in chronic AAS users (Abdullah et al, 2024; Rasmussen et al., 2018; Baggish et al., 2017). This discrepancy likely stems from fundamental methodological differences, such as the absence of randomization, heterogeneous participant profiles, and the use of substantially higher doses in uncontrolled settings (Fanaroff et al.,2020; Câmara, 2024).
Despite these differences, it is important to recognize the limitations of the analyzed RCTs, particularly their small sample sizes and reliance on conventional echocardiographic methods,which may not be sufficiently sensitive to detect early or subtle cardiac changes (Hartgens et al.,2003; Chung et al., 2007). The integration of more advanced imaging techniques, such as cardiac magnetic resonance imaging and speckle-tracking analysis, could enhance the precision of future assessments (Sitia et al.,2010; Brandt et al., 2024; Magalhães et al., 2024). Moreover, while therapeutic clinical trials have suggested the safety of ND at similar doses (200 mg/week) over longer periods (Cattran et al., 1977; Johansen et al., 2006; Gascón et al., 1999; Williams et al., 1974;Navarro et al., 2002), extrapolating these findings to recreational users requires caution due to factors such as polypharmacy and individual susceptibilities.
Given these considerations, there is a pressing need for well-designed RCTs with larger sample sizes, appropriate statistical power calculations, and advanced cardiac imaging methodologies to further clarify the cardiovascular effects of ND. Until stronger and more definitive evidence becomes available, it would be prudent to ensure that any individuals using high doses of ND undergo comprehensive cardiac evaluations,facilitating the early detection of potential risks and optimizing long-term cardiovascular monitoring.
Aims
The cardiovascular risks associated with anabolic-androgenic steroid (AAS) use, particularly nandrolone decanoate (ND), remain a topic of debate due to conflicting evidence from different types of studies. While observational research frequently reports adverse cardiac effects, findings from randomized controlled trials (RCTs) suggest otherwise. This review aims to critically assess the available RCTs evaluating the impact of ND on cardiac morphology and function, with a focus on their methodological quality and clinical relevance.Study Design: Structured review of randomized controlled trials.
Methods
A systematic literature search was conducted to identify RCTs that examined the effects of ND on cardiac function. The analysis included study design, sample size, inclusion/exclusion criteria, cardiac evaluation methods, and reported outcomes. The methodological quality of each study was assessed using the Jadad scale to ensure a rigorous evaluation of the evidence.
Results
The two reviewed RCTs, which were of moderate to high methodological quality, did not report clinically significant cardiac dysfunction in healthy individuals after short-term exposure toND. However, these findings contrast with several observational studies, where users—often exposed to uncontrolled conditions and higher doses—frequently present with structural and functional cardiac changes. A key limitation of the RCTs was their small sample sizes, short follow up durations, and reliance on conventional imaging techniques, which may not be sensitive enough to detect subtle cardiac alterations.
Conclusion
While current RCTs do not provide strong evidence of cardiovascular harm from ND,their methodological limitations underscore the need for further research. Future trials with larger sample sizes, higher statistical power, and more advanced cardiac imaging techniques will be crucial in clarifying the true impact of ND on the heart. Until more definitive data are available,routine cardiac monitoring should be considered for individuals using ND, particularly those on prolonged or high-dose regimens.
------------------
5. CONCLUSION
The available RCTs, conducted with moderate to high methodological quality, did not demonstrate clinically significant adverse effects on cardiac morphology or function in young, healthy individuals following short-term administration of ND (Hartgens et al., 2003; Chung et al., 2007). However, these findings contrast with those from observational studies, which frequently report deleterious cardiovascular changes in chronic AAS users (Abdullah et al, 2024; Rasmussen et al., 2018; Baggish et al., 2017). This discrepancy likely stems from fundamental methodological differences, such as the absence of randomization, heterogeneous participant profiles, and the use of substantially higher doses in uncontrolled settings (Fanaroff et al.,2020; Câmara, 2024).
Despite these differences, it is important to recognize the limitations of the analyzed RCTs, particularly their small sample sizes and reliance on conventional echocardiographic methods,which may not be sufficiently sensitive to detect early or subtle cardiac changes (Hartgens et al.,2003; Chung et al., 2007). The integration of more advanced imaging techniques, such as cardiac magnetic resonance imaging and speckle-tracking analysis, could enhance the precision of future assessments (Sitia et al.,2010; Brandt et al., 2024; Magalhães et al., 2024). Moreover, while therapeutic clinical trials have suggested the safety of ND at similar doses (200 mg/week) over longer periods (Cattran et al., 1977; Johansen et al., 2006; Gascón et al., 1999; Williams et al., 1974;Navarro et al., 2002), extrapolating these findings to recreational users requires caution due to factors such as polypharmacy and individual susceptibilities.
Given these considerations, there is a pressing need for well-designed RCTs with larger sample sizes, appropriate statistical power calculations, and advanced cardiac imaging methodologies to further clarify the cardiovascular effects of ND. Until stronger and more definitive evidence becomes available, it would be prudent to ensure that any individuals using high doses of ND undergo comprehensive cardiac evaluations,facilitating the early detection of potential risks and optimizing long-term cardiovascular monitoring.
