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Doping is the use of a substance that artificially increases an individual's physical ability for competition purpose. Products and methods used in doping are not without risk, especially at cardiovascular level. Here we review the most common doping substances in sport and their cardiovascular consequences., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

We report a case of methandienone misuse leading to a preventive action of the Lorraine medicale anti-doping unit., (© 2014 Société Française de Pharmacologie et de Thérapeutique.)

Doping consists in the use of artificial means or substances with the unique aim of improving performance despite adverse effects on health. Amphetamines stimulate the central nervous system by increasing motivation and vigilance. Often consumed in association with analgesics, they increase the fatigue threshold during prolonged or repeated exercise. Addiction and dependency to these substances are extremely rapid. Side-effects include insomnia, exhaustion, violence and can lead to serious heart diseases. By enhancing capacity for intensive training, anabolic steroids improve strength, alertness and speed. This action is often further strengthened by the use of growth hormones DHEA and IGF-1. Extremely high dosage is used and is in no way comparable with natural secretions or those necessary to re-balance an exhausted glandular system. During prolonged endurance exercise, doping aims at improving the circulation of oxygen in the blood and thus its availability to the muscles. Firstly, the blood haemoglobin concentration was increased by blood transfusions. At present the production of red blood cells is stimulated by repeated injections of exogenous erythropoietin. The extreme viscosity of the blood leads to a risk of vascular thromboses and high blood pressure and accentuates greatly and sometimes even fatally the possibility of brachycardia which is common with sportsmen.

Several compounds listed as illicit doping agents can express some effects on the skin. The cutaneous signs are diverse. The clue of the intake of such compounds can be supported by objective non-invasive biometrological assessments. However, such evaluations do not bring the irrefutable proof. The skin can also present unwanted reactions indicating intolerance to the doping agent. Such physiopathological manifestations are not limited to the sport competition, but can also affect some groups of the population searching for a look reminiscent of the ideal young and performing athlete.

The use of doping is linked with the history of sports. Doping abuse escalated until the mid sixties when government and sports authorities responded with antidoping laws and drug testing. Today, the details of substances detected in controls give a good indication on the importance of doping use. Three classes of pharmaceuticals account for most of the positive controls. They are anabolic steroids, stimulants and narcotics. Their use can be related with the goal of the athletes. Anabolic steroids are mainly used in sports such as bodybuilding or weight lifting in order to develop strength. Stimulants are used in sports were speed favors performance. All the products that enhance blood oxygen transportation are used in endurance sports, their efficacy is not scientifically demonstrated, but their use does result in real risks. Several studies have evidenced the medical problems resulting from prolonged doping. Doping control is impaired by the fact that many products now used, e.g. EPO or rhGH, are not detectable. Regular medical examination of athletes could help prevent use of doping.

Prevalence: Whatever method is used (observation, interviews, questionnaire, laboratory tests), it is difficult to collect epidemiological data on doping. Particularly difficult problems are related to the definitions of sports players and the drugs involved as well as the often illicit nature of drug use., Results: The prevalence of doping in children and adolescents participating in sports is estimated at 3% to 5% with higher percentages in boys, older adolescents and those playing at a competition level. Use of anabolic steroids, as early as 8 years of age, has increased since 1990, especially in girls. All studies have emphasized how easy it is for adolescents to procure any prohibited drug. In adults participating in amateur sports, the prevalence of doping would be 5% to 15%. All sports are involved with higher prevalence in men, age ranges 20-25 years and 35-39 years, and competitive level players. The main drugs used are stimulants, narcotics, corticosteroids and anabolic steroids. Combination of at least 2 drugs is frequent with an increase of mean daily dose over the last 15 years. According to users, the drugs are obtained with a medical prescription, on the underground market, or from other participants. Few data are available on doping outside sports activities. In the French department Meurthe-et-Moselle, 15% of the inhabitants use drugs to improve their occupational performance., Conclusions: Doping is more widespread than would be expected from antidoping control data. Other studies are needed to acquire more precise epidemiological data.

The potential cardiotoxicity of anabolic steroids is not well known. The authors report the case of a young man who was a top class body builder and who developed severe ischaemic cardiomyopathy presenting with an inferior wall myocardial infarction. The clinical history revealed prolonged and intensive usage of two types of anabolic steroids to be the only risk factor. This cardiotoxicity may be related to several physiopathological mechanisms: accelerated atherogenesis by lipid changes, increased platelet aggregation, coronary spasm or a direct toxic effect on the myocytes. The apparent scarcity of the reported clinical details in the literature is probably an underestimation of the consequences of this usage.

Doping is defined as the administration of or use by competing athletes of any substance foreign to the body or of any physiological substance taken in abnormal quantity or taken by an abnormal route of entry into the body with the sole intention of increasing in an artificial and unfair manner his/her performance in competition. The prevalence of doping has been estimated by rigorous methods to be 5-15%. The only two dopings of established efficacy are: anabolic steroids for resistive performance, and blood doping for endurance performance. Although medical control of athletes is reputably poor, reported accidents attributable to doping have been until now very rare. Doping is unfair, and must as such be banned from competitions. Medicalized doping is unethical. More studies are required to improve knowledge of doping as a public health issue. Sports medicine is in need of scientific and moral revalorization.

A rational use of veterinary drugs is one of the essential factors in the production of healthy food of animal origin, but residues may persist in such foods. These residues are present in very small amounts, and they create no public health problem as long as their toxicological significance is evaluated scientifically. This evaluation, which is made for each veterinary drug prior to applying for authorization to market, leads to the definition of tolerable residual levels as a measure designed to protect the customers. This general principle is illustrated by two examples: the risk of allergic intolerance to foods, due to traces of particularly active substances, such as penicillins; such residues may occasionally be allergenic, but they are certainly not immunogenic; the problems associated with the use of hormonal or hormone-related compounds endowed with anabolic properties. The current interdiction of these compounds does not rest on solid scientific grounds.

Since 1977, 22 patients with hereditary angioneurotic oedema have been treated with androgenic-anabolic steroids (danazol or stanozolol). The most frequent adverse reactions were myalgia, weight increase, changes in libido, and menstrual disorders in women. In view of these side-effects, it is suggested that patients about to undergo surgery (chiefly E.N.T. or stomatology) should be put, one week before the operation, on a 10-day high dosage treatment. Long-term treatment should be reserved to severe forms of the disease, with frequent attacks and visceral involvement, using the minimum effective dosage (which is always low) without trying to correct biochemical abnormalities. Stanozolol should be given by preference to men and danazol to women. Treatment is always more difficult in pre-menopausal women. With this method, the complications, notably hepatic disorders, are rare, and long-term treatment, when absolutely necessary, is well tolerated.