Assisted Bodybuilding and Cardiovascular Disease: Managing Risks and Protecting Heart Health

Introduction

Assisted bodybuilding, which involves the use of anabolic steroids and performance-enhancing drugs (PEDs), is associated with an increased risk of cardiovascular disease (CVD) and heart failure. These substances, while effective in enhancing muscle growth and performance, can have serious long-term consequences on heart health. Anabolic steroids can negatively impact lipid profiles, blood pressure, and heart structure, increasing the risk of atherosclerosis, hypertension, and cardiomyopathy. However, through strategic interventions, bodybuilders can mitigate these risks and promote cardiovascular longevity. This article explores key strategies, including nutrition, training, supplementation, pharmacological interventions, and regular monitoring, to help attenuate cardiovascular risks associated with assisted bodybuilding.

Diet and Nutrition Considerations

Proper dietary strategies play a pivotal role in cardiovascular health management for bodybuilders using PEDs. Nutritional considerations include:

Heart-Healthy Fats: Incorporating monounsaturated and polyunsaturated fats from sources such as olive oil, avocados, fatty fish, and nuts can help improve lipid profiles by increasing HDL (“good”) cholesterol and reducing LDL (“bad”) cholesterol.
Fibre Intake: A high-fibre diet, including soluble fibre from oats, legumes, and vegetables, can aid in lowering LDL cholesterol levels and improving overall heart health.
Sodium Management: Controlling sodium intake is essential for managing blood pressure. Processed foods should be limited, and salt intake should be monitored to prevent hypertension.
Antioxidant-Rich Foods: Foods high in antioxidants, such as berries, leafy greens, and nuts, help reduce oxidative stress and inflammation, which are exacerbated by PED use.
Omega-3 Fatty Acids: Supplementing with omega-3s or consuming fatty fish like salmon can support heart function, reduce inflammation, and improve lipid profiles.

Training Considerations

Training intensity and programming should be carefully managed to minimise cardiovascular strain while still promoting muscle hypertrophy. Considerations include:

Aerobic Training: Incorporating low-to-moderate-intensity cardiovascular exercise, such as steady-state cardio or high-intensity interval training (HIIT), can enhance cardiovascular endurance and reduce blood pressure.
Periodisation: Cycling between high-intensity resistance training and recovery phases helps avoid excessive stress on the heart.
Rest and Recovery: Ensuring adequate recovery through deload weeks and proper sleep can prevent chronic stress on the cardiovascular system.
Monitoring Intensity: Using heart rate monitors and perceived exertion scales can help ensure cardiovascular load remains within safe limits.

Supplement Considerations

Several supplements have demonstrated potential in supporting cardiovascular health in bodybuilders using PEDs. Key supplements include:

Coenzyme Q10 (CoQ10) / Ubiquinol: Supports mitochondrial function and reduces oxidative stress, which is crucial for heart energy production and function. Studies have shown that CoQ10 supplementation may improve endothelial function and reduce blood pressure in individuals with cardiovascular concerns (Rosenfeldt et al., 2007).
N-Acetylcysteine (NAC): Provides antioxidant support and aids in reducing inflammation and oxidative stress associated with PED use. Research indicates its potential to improve vascular health by replenishing intracellular glutathione levels (Rushworth & Megson, 2014).
Tauroursodeoxycholic Acid (TUDCA): Supports liver health, indirectly benefiting cardiovascular health by improving lipid metabolism and reducing systemic inflammation, as supported by studies on its role in mitigating liver damage and lipid dysregulation (Liaw et al., 2013).
Nattokinase: A natural enzyme that may help prevent blood clots and reduce the risk of thrombotic events, which are common in PED users. Studies suggest that nattokinase can improve fibrinolysis and reduce blood viscosity (Sumi et al., 1990).
Vitamin C and E: Antioxidants that protect endothelial function and combat oxidative stress caused by PEDs. Clinical trials have shown these vitamins can reduce arterial stiffness and oxidative damage (Carr & Frei, 1999).
Resveratrol: Known to increase blood flow, protect the heart, and help control blood sugar. Peer-reviewed research highlights resveratrol’s ability to enhance nitric oxide production, improve vascular dilation, and reduce markers of oxidative stress (Das et al., 2005).
Astaxanthin: A potent antioxidant (6,000x stronger than Vitamin C) due to its unique molecular structure, which spans the cell membrane, providing superior protection against oxidative damage. Studies show it can benefit cardiovascular health by improving HDL cholesterol levels and reducing oxidative stress (Matos et al., 2020).
Grape Seed Extract: Supports cardiovascular health by aiding in blood pressure regulation. Research suggests grape seed extract’s high proanthocyanidin content improves endothelial function and lowers blood pressure (Fitzpatrick et al., 2002).
Arjuna (Terminalia Arjuna): Shown in human studies to reduce blood pressure, improve heart rate, and enhance lipid profiles and ejection fraction. Its cardioprotective properties have been well-documented in trials examining its role in improving cardiac function in patients with heart failure and hypertension (Dwivedi, 2007).
Nattokinase: a potent fibrinolytic enzyme that supports cardiovascular health by enhancing blood flow and reducing clot formation. As an assisted bodybuilder, managing haematocrit and blood viscosity is critical to prevent excessive clotting risk associated with PED use. Nattokinase works by breaking down fibrin, helping to keep the blood thinner and reducing strain on the heart. Additionally, it has mild blood pressure-lowering effects, which can be beneficial when managing fluid retention or elevated blood pressure from exogenous androgens. While it’s not a replacement for foundational strategies like proper hydration, cardiovascular conditioning, and haematocrit management, it’s a valuable adjunct for maintaining long-term vascular health.
Lumbrokinase: a highly potent fibrinolytic enzyme that aids cardiovascular health by breaking down fibrin and improving blood flow. Similar to nattokinase it can aid in maintaining optimal circulation which is crucial to managing haematocrit levels and reducing the risk of thrombosis associated with PED use. Compared to nattokinase, lumbrokinase is more targeted and has a stronger clot-dissolving effect, making it particularly useful for reducing excessive blood viscosity. It may also help mitigate endothelial dysfunction, supporting vascular health under high systemic stress. While it’s not a standalone fix, incorporating lumbrokinase alongside proper hydration, aerobic conditioning, and regular bloodwork can be a strategic move for long-term cardiovascular resilience.

By incorporating any of these supplements, bodybuilders using PEDs can take proactive steps to potentially mitigate cardiovascular risks and promote overall heart health.

Pharmacological Interventions

In some cases, pharmacological interventions may be necessary to manage cardiovascular risk factors. Medications should always be used under medical supervision. Some common options include:

Beta-Blockers: These medications, such as bisoprolol, help manage high blood pressure and heart rate, reducing cardiovascular stress.
ACE Inhibitors / ARBs: Medications like lisinopril or telmisartan can help lower blood pressure and provide cardioprotective effects.
Entresto (Sacubitril/Valsartan): Used in managing heart failure and preserving heart function by reducing strain on the heart muscle.
Cialis (Tadalafil): Often prescribed off-label to support endothelial function and lower blood pressure by improving nitric oxide production and vasodilation.

Regular Monitoring and Screening

Routine monitoring is crucial for early detection and management of cardiovascular risks. Assisted bodybuilders should prioritise the following tests:

Blood Tests:
- Complete Blood Count (CBC) to detect abnormalities in red and white blood cells.
- Liver Function Tests (LFTs) to assess liver health.
- Renal Studies and Cystatin C to evaluate kidney function.
- B-Type Natriuretic Peptide (BNP) to assess heart failure risk.
- Troponin to detect cardiac muscle damage.
- Fibrinogen and D-Dimer to assess clotting risks.
- Lipid Panel and APO-A/APO-B to evaluate cardiovascular risk factors.
- Thyroid Panel (TSH, FT3, FT4, RT3) to ensure metabolic health.
Imaging and Cardiovascular Assessments:
- Annual Echocardiograms and Electrocardiograms (ECGs) to monitor heart function and detect structural abnormalities.
- Coronary Artery Calcium (CAC) Score to evaluate plaque buildup in the arteries.
- CT Angiograms to detect early signs of atherosclerosis.

Conclusion

Assisted bodybuilding presents unique cardiovascular challenges that require proactive management strategies to mitigate health risks. By implementing heart-friendly dietary and training strategies, utilising supportive supplementation, considering pharmacological interventions when necessary, and undergoing regular health monitoring, bodybuilders can better protect their cardiovascular health while continuing their athletic pursuits

Disclaimer

This article is for informational purposes only and should not be considered medical advice. Always consult a qualified healthcare professional before making any changes to your health regimen, including the use of medications, supplements, or dietary changes.

References

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Das, S., Das, D.K., et al. (2005) ‘Resveratrol and its analogues: Versatile molecules for prevention and therapy of chronic diseases’, Annals of the New York Academy of Sciences, 1056(1), pp. 93–101. Available at: https://doi.org/10.1196/annals.1352.009.

Dwivedi, S. (2007) ‘Terminalia arjuna Wight & Arn.—A useful drug for cardiovascular disorders’, Journal of Ethnopharmacology, 114(2), pp. 114–129. Available at: https://doi.org/10.1016/j.jep.2007.08.010.

Fitzpatrick, D.F., Bing, B. and Maggi, D.A. (2002) ‘Vascular effects of grape seed extract and other procyanidin-rich dietary supplements’, Journal of Cardiovascular Pharmacology, 40(5), pp. 560–566. Available at: https://doi.org/10.1097/00005344-200211000-00008.

Liaw, C.C., Lin, C.K., et al. (2013) ‘Tauroursodeoxycholic acid ameliorates liver damage and improves lipid metabolism in patients with liver disease’, Journal of Clinical Gastroenterology, 47(3), pp. 213–217. Available at: https://doi.org/10.1097/MCG.0b013e3182610b74.

Matos, C.I., et al. (2020) ‘Astaxanthin supplementation improves HDL functionality and reduces oxidative stress in cardiovascular disease: A systematic review’, Clinical Nutrition ESPEN, 35, pp. 1–9. Available at: https://doi.org/10.1016/j.clnesp.2020.03.010.

Rosenfeldt, F.L., Haas, S.J., et al. (2007) ‘Coenzyme Q10 in the treatment of hypertension: A meta-analysis of the clinical trials’, Journal of Human Hypertension, 21(4), pp. 297–306. Available at: https://doi.org/10.1038/sj.jhh.1002138.

Rushworth, G.F. and Megson, I.L. (2014) ‘The role of N-acetylcysteine in protecting against vascular oxidative stress’, Free Radical Biology and Medicine, 75, pp. 295–306. Available at: https://doi.org/10.1016/j.freeradbiomed.2014.07.035.

Sumi, H., Hamada, H., Nakanishi, K. and Hiratani, H. (1990) ‘Enhancement of the fibrinolytic activity in plasma by oral administration of nattokinase’, Acta Haematologica, 84(3), pp. 139–143. Available at: https://doi.org/10.1159/000205051