Associations between legal performance-enhancing substance use and future cardiovascular disease risk factors in young adults: A prospective cohort study

• Type of Material: Article
• Authors: Jason M. Nagata, University of California, San Francisco; Kyle T. Ganson, University of Toronto; Mitchell L. Cunningham, University of Sydney; Deborah Mitchison, Western Sydney University; Jason M. Lavender, Uniformed Services University of the Health Sciences; Aaron J. Blashill, San Diego State University; Holly Gooding, Emory University; Stuart B. Murray, University of Southern California
• Language: English
• Date: 2020-12-15
• Publisher: PUBLIC LIBRARY SCIENCE
• Publication Version: Final Published Version
• Copyright Statement: 2020
• License: Creative Commons Universal : Public Domain Dedication
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0244018
• Title of Journal or Parent Work: PLOS ONE
• Volume: 15
• Issue: 12
• Start Page: e0244018
• End Page: e0244018
• Grant/Funding Information: J.M.N was a participant in the Pediatric Scientist Development Program and is supported by the American Heart Association (CDA34760281, https://www.heart.org/). H.C.G. is supported by the National Institutes of Health K23 HL122361 (https://www.nih.gov/). S.B.M. is supported by the National Institutes of Health K23 MH115184. This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. No direct support was received from grant P01-HD31921 for this analysis. The opinions and assertions expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University or the U.S. Department of Defense. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
• Keywords: HEALTH; CREATINE SUPPLEMENTATION; CONSEQUENCES; NUTRITIONAL SUPPLEMENTS; ADHD; Multidisciplinary Sciences; DRUGS; ADOLESCENTS; Science & Technology - Other Topics; Science & Technology; TERM; PREVALENCE; ANABOLIC-ANDROGENIC STEROIDS
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Nutrition

Abstract

Background Legal performance-enhancing substances (PES), such as creatine, are commonly used by adolescents and young adults. As PES are mostly unregulated by the US Food and Drug Administration, there has been limited empirical attention devoted to examining their longterm safety and health outcomes. Preliminary studies have demonstrated associations between PES use and severe medical events, including hospitalizations and death. PES could be linked to cardiovascular disease (CVD), the most common cause of mortality in the US, by altering the myocardium, vasculature, or metabolism. The objective of this study was to examine prospective associations between the use of legal PES in young adulthood and CVD risk factors at seven-year follow-up. Materials and methods Nationally representative longitudinal cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves III (2001-2002) and IV (2008), were analyzed. Regression models determined the prospective association between the use of legal PES (e.g. creatine monohydrate) and CVD risk factors (e.g. body mass index, diabetes, hypertension, hyperlipidemia), adjusting for relevant covariates. Results Among the diverse sample of 11, 996 male and female participants, no significant differences by PES use in body mass index, diabetes, hypertension, or hyperlipidemia were noted at Wave III. In unadjusted comparisons, legal PES users (versus non-users) were more likely to be White, be male, be college educated, drink alcohol, and engage in weightlifting, exercise, individual sports, team sports, and other strength training. There were no significant prospective associations between legal PES use at Wave III and body mass index, hemoglobin A1c, systolic and diastolic blood pressure, and cholesterol (total, HDL, LDL, triglycerides) deciles at seven-year follow-up (Wave IV), adjusting for demographics, health behaviors, and Wave III CVD risk factors. Similarly, there were no significant prospective associations between legal PES use and diabetes, hypertension, or hyperlipidemia based on objective measures or self-reported medications and diagnoses, adjusting for demographics, health behaviors, and Wave III CVD risk. Conclusions We do not find evidence for a prospective association between legal PES use and CVD risk factors in young adults over seven years of follow-up, including BMI, diabetes, hypertension, or hyperlipidemia. It should be noted that legal PES use was operationalized dichotomously and as one broad category, which did not account for frequency, amount, or duration of use. Given the lack of regulation and clinical trials data, observational studies can provide much needed data to inform the safety and long-term health associations of legal PES use and, in turn, inform clinical guidance and policy.