From:  Beyond anabolic steroids: cardiovascular collapse in the modern physique enhancement era

 Common performance-enhancing practices and potential cardiovascular consequences in modern bodybuilding.

Practice/SubstanceMain purposePotential cardiovascular effectsClinical consequencesEvidence type
AASMuscle hypertrophyLVH, fibrosis, dyslipidemiaArrhythmias, cardiomyopathy, SCDObservational studies, autopsy studies
GH/IGF-1AnabolismCardiac hypertrophyDiastolic dysfunction, remodelingObservational studies
InsulinNutrient partitioningMetabolic instabilityHypoglycemia, electrolyte disturbancesObservational studies
T3/T4Fat lossTachycardia, sympathetic activationArrhythmias, ischemiaCase reports, observational studies
ClenbuterolThermogenesisTachycardia, ischemiaArrhythmias, ACSCase reports
DiureticsWater reductionHypo/hyperkalemiaVT/VF, SCDCase reports, observational studies
Peak week dehydrationAesthetic preparationHemoconcentrationThrombosis, SCDObservational studies

AAS: anabolic-androgenic steroids; GH: growth hormone; IGF-1: insulin-like growth factor-1; LVH: left ventricular hypertrophy; SCD: sudden cardiac deaths; VT: ventricular tachycardia; VF: ventricular fibrillation. Evidence types reflect the predominant sources available in the current literature and should not be interpreted as formal evidence grading.