I really don't understand these attempts by some people to suppress others from trying to learn about a subject that let's face it, many put their head in the sand about.
Clearly we have physicians in this thread providing information.
Me, personally - I'm reading what is said and learning a bit.
A few things...
If by way of a side effect caused by sheer speculation you happen to learn something about cardiac physiology, that is absolutely fine. That is one of the great things about this forum, in that there is a wealth of information that many members have regarding matters surrounding close to just about anything that is openly shared amongst its members. While sharing information is great, it is very important to make sure that said information is factual and backed by studies and actual clinical data that supports what is being said. If you "learn" something here that is not necessarily true and then share it with others who might be pretty knowledgeable about the matter (say an actual cardiologist etc), it will sound a bit odd to them.
Clearly, there is no suggestion that anyone in this thread is an actual physician. Being a med student does not make one a physician. Heck, being a PGY1-3 (IM resident), also barely makes one a qualified physician since they are still learning and can't practice outside of a hospital.
I think many of the things Danny-boy has said are pretty sound, but there was one thing (the reversibility of cardiac hypertrophy in particular), that I do not believe is correct.
For instance, this statement suggests that:
Induced growth of cardiomyocyctes is irreversible my friend.....as seen in cases of hypertrophy, where the ventricle is forced to increase contractility in order to provide more oxygenated blood due to higher demand.... Follow physics...power = length x tension ... Something is going to have to give ...it was just a matter of time.. The human body can only compensate to a certain futile degree..... All the abusive factors contributed to his accelerated demise... And yes..numerous past bodybuilders of the 70s did indeed undergo bypass surgery of some form- although not the hypertrophic acceleration seen in generation GH coupled w other anabolic enhancements...
The statement in bold above is not correct. It is stated as an absolute and it is not necessarily true.
Cardiomyocyte (heart muscle) growth is reversible if caught early on enough. If Danny, or anyone else for that matter, can disprove that ventricular hypertrophy (as seen in patients with HTN-Hypertension) is irreversible, regardless of stage, I'd gladly ask them to post the peer reviewed studies to suggest otherwise.
For instance, here in UpToDate, which tends to be one of the top 5 clinician go-to guides, it states clearly that ventricular hypertrophy (induced growth of cariomyocytes) by way of hypertension can be reversed:
(
Notice how under the effects of antihypertensive therapy, it mentions how treatment for HTN will decrease mass in patients with left ventricular hypertrophy and a regression of hypertrophy can be seen. If induced cardiomyocyte growth was truly irreversible, there would be no way for this statement to be true and backed by not just hundreds of studies, but by the American Heart Association)
Not to mention, that it is
VERY normal for adamant weightlifters to have mild-moderate left ventricular hypertrophy due to the excessive amount of weights that they lift. Once the stimuli is removed (be it hypertension or prolonged power-lifting, the hypertrophy will typically reverse).
Prolonged hypertrophy that goes untreated can result in heart failure, because like that of a rubber band, the heart muscle can only stretch but so much in order to compensate for the increased workload/demand in putting out oxygenated blood to the systemic circulation.
For more peer-reviewed readings that state clearly that ventricular hypertrophy is reversible, feel free to take a read at:
Ruilope LM, Schmieder RE. Left ventricular hypertrophy and clinical outcomes in hypertensive patients. Am J Hypertens 2008; 21:500.
(
http://www.uptodate.com/contents/clinical-implications-and-treatment-of-left-ventricular-hypertrophy-in-hypertension/abstract/20)
Franz IW, Tönnesmann U, Müller JF. Time course of complete normalization of left ventricular hypertrophy during long-term antihypertensive therapy with angiotensin converting enzyme inhibitors. Am J Hypertens 1998; 11:631.
(
http://www.uptodate.com/contents/clinical-implications-and-treatment-of-left-ventricular-hypertrophy-in-hypertension/abstract/21)
Cuspidi C, Negri F, Zanchetti A. Angiotensin II receptor blockers and cardiovascular protection: focus on left ventricular hypertrophy regression and atrial fibrillation prevention. Vasc Health Risk Manag 2008; 4:67.
(
http://www.uptodate.com/contents/clinical-implications-and-treatment-of-left-ventricular-hypertrophy-in-hypertension/abstract/22)
Okin PM, Devereux RB, Gerdts E, et al. Impact of diabetes mellitus on regression of electrocardiographic left ventricular hypertrophy and the prediction of outcome during antihypertensive therapy: the Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension Study. Circulation 2006; 113:1588. (
http://www.uptodate.com/contents/clinical-implications-and-treatment-of-left-ventricular-hypertrophy-in-hypertension/abstract/23)
Os I, Franco V, Kjeldsen SE, et al. Effects of losartan in women with hypertension and left ventricular hypertrophy: results from the Losartan Intervention for Endpoint Reduction in Hypertension Study. Hypertension 2008; 51:1103.
(
http://www.uptodate.com/contents/clinical-implications-and-treatment-of-left-ventricular-hypertrophy-in-hypertension/abstract/24)
Solomon SD, Appelbaum E, Manning WJ, et al. Effect of the direct Renin inhibitor aliskiren, the Angiotensin receptor blocker losartan, or both on left ventricular mass in patients with hypertension and left ventricular hypertrophy. Circulation 2009; 119:530.
(
http://www.uptodate.com/contents/clinical-implications-and-treatment-of-left-ventricular-hypertrophy-in-hypertension/abstract/25)
That's the only issue I had with Danny's post.
The vast majority of what he posted is sound and makes excellent sense, but I disagree in that induced cardiomyocyte growth (as particular seen in ventricular hypertrophy) is irreversible as an absolute statement. If not treated early on, then yes, heart failure can ensue due to excessive cardiac remodeling that after enough time seizes to compensate for the demands of the heart.
Haha, classic denialist mentality stuff....
Steroids lead to permanent myocardial fibrosis and micro scarring leading to reduced efficiency, disturbed electrical conductivity and the leading cause of heart failure over any of the other issues that have have been highlighted above.
If you can post some peer-reviewed studies to substantiate your statements that steroid use will directly lead to the development of myocardial fibrosis and that steroid use is the leading cause of heart failure over other issues like Hypertension, I will gladly read them and evaluate, but for now those are just random, unsubstantiated statements.
Not everything that is spewed should be taken as gospel.
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P.S. I knew Kovacs. I met him through Desmond Miller and Victor Martinez. The guy wasn't the friendliest guy and towards the end (last 5 years of his life) he became pretty bitter towards the "sport".
