The use of anabolic androgenic steroids could be associated with early onset coronary artery disease, according to research presented Nov. 4 at the Brazilian Congress of Cardiology.

Around one million Brazilians have used anabolic androgenic steroids at least once, the researchers explained, making them the seventh most commonly used drug in the country.

“Anabolic androgenic steroid abuse among young people is a widespread problem worldwide, and adverse events such as sudden cardiac death and heart attack have been reported in athletes,” lead study author Francis Ribeiro de Souza, PhD, said in a press release.

Ribeiro de Souza and colleagues studied 51 men who were an average of 29 years old. Twenty-one of them lifted weights and had taken steroids for at least two years, 20 lifted weights but did not use steroids and 10 were healthy but sedentary.

Atherosclerosis—assessed via CT angiography—was present in the coronary arteries of 24 percent of the steroid users compared to none of the non-users in the weightlifting or sedentary groups. The steroid users also had lower high-density lipoprotein (HDL) cholesterol levels and reduced HDL function.

“Our study suggests that anabolic androgenic steroid use may be associated with the development of coronary artery disease in apparently healthy young people,” Ribeiro de Souza said. “Steroids may have an impact on the ability of HDL to remove cholesterol from macrophages, thereby promoting atherosclerosis.”

Ribeiro de Souza said because the study was small and observational in nature, it couldn’t definitively tie steroid use to atherosclerosis. Larger, longer-term studies are warranted, he said.

“This study despite its small sample size is well done and calls attention to a possible important health problem in Brazil and elsewhere since it shows not only the classical lipid disturbances induced by steroids but actually associates them with subclinical atherosclerosis presence, something that we are not supposed to find in young individuals,” said Raul Santos, MD, PhD, the scientific chair of the conference.