Performance-enhancing drugs, supplements and the athlete's heart

Andrew Pipe
2017 SA Heart Journal  
The List) is reviewed annually and comments and contributions from the sport community regarding any proposed changes are welcomed and encouraged. At the same time it is recognised that the legitimate health needs of many athletes may frequently require the use of otherwise prohibited medications. The WADA Code provides for the administration of such medications following special application and a review of a particular case by a suitably qualified panel of clinicians. The use of many
more » ... drugs is not restricted to the elite; such drug-taking behaviour can be seen at virtually every level of sport. (5-7) It is equally important to recognise that the use of prohibited substances is not limited to those involved in competitive activities; many young adults use a variety of drugs and other substances in attempts to enhance their physique or in the pursuit of mood-altering experiences. The use of so-called nutritional Minto Prevention ABSTRACT 164 PERFORMANCE-ENHANCING DRUGS AND THE HEART INTRODUCTION The use of performance-enhancing drugs is an unfortunate reality of sport. (1,2) Since 2004, responsibility for the development, application and oversight of international anti-doping activities has been vested in the World Anti-Doping Agency (WADA) headquartered in Montreal, Canada and supported by the international sport community principally through the International Olympic Committee (IOC), international sport organisations (ISOs), and international governments. Responsibility for the implementation of testing and adjudication procedures in sport rests with International Sport Organisations (ISOs), National Sport Federations (NSFs) and National Anti-Doping Organisations (NADOs). (3) The development of WADA, and more specifically the adoption of the WADA Code, has meant that there is now consistency between and among sport organisations at virtually every level in the approach taken to address the doping issue e.g. harmonised testing standards, review processes and sanctions. (4) In North America, professional sport organisations have been slow to adopt the approaches that are found more consistently throughout the rest of the world. It is a committee of WADA, the "List Committee", that ultimately determines what substances and methods are prohibited in sport. A substance can be considered for inclusion if it meets two of three criteria: it enhances performance; it is harmful to health; and/or its use contravenes the "spirit of sport". The prohibited list The use of performance-enhancing drugs is an unfortunate reality of contemporary sport. It would be a mistake to believe that this is a phenomenon found only in elite sport. Athletes at all levels and young adults may be tempted to accentuate performance or physique with prohibited drugs or products marketed as supplements. No defi ned populations of users ingesting known quantities of known substances are generally available for study. Many of these products have been associated with adverse health effects; cardiac structure and function are known to be affected by many of the products commonly abused. Changes to the lipoprotein profi le, propensity for coagulation, coronary circulation, and ventricular function may accompany the use of many performance-enhancing compounds and methods. Anabolic steroids, other peptide hormones, stimulants, erythropoietin and blood doping, have all been associated with signifi cant cardiovascular consequences. So-called nutritional supplements aggressively marketed to the athletically inclined, are available over the Internet and typically totally unregulated in the country of their origin. Clinicians should be aware of the problems that such drug use can engender, and be sensitive to the possibilities of such abuse in caring for athletes and young patients, particularly in those presenting with unusual or unanticipated cardiovascular signs and symptoms.
doi:10.24170/8-3-1895 fatcat:4yynqoydbngb7dedgyeqluo3wa