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

 Key cardiovascular risk factors, underlying mechanisms, and potential cardiovascular consequences associated with modern bodybuilding practices.

Risk factorMechanismPotential outcome
AASFibrosis, LVHArrhythmias
GH/IGF-1HypertrophyRemodeling
InsulinElectrolyte shiftsArrhythmias
DiureticsHypo-/hyperkalemiaVT/VF
DehydrationHemoconcentrationThrombosis
StimulantsSympathetic activationIschemia
Genetic susceptibilityChannelopathies, cardiomyopathiesSCD

AAS: anabolic-androgenic steroids; GH: growth hormone; IGF-1: insulin-like growth factor-1; LVH: left ventricular hypertrophy; VT: ventricular tachycardia; VF: ventricular fibrillation; SCD: sudden cardiac deaths. The table provides a simplified summary of the principal cardiovascular risk factors and potential pathways discussed throughout the review and should not be interpreted as evidence of direct causality.