Steroids and Heart Health: Which Anabolic Steroids Impact Cholesterol and Cardiovascular Risk?

Anabolic steroids (AAS) are often associated with rapid muscle gain, strength increases, and body recomposition. But what’s often left out of the conversation is their profound impact on cardiovascular health—specifically their ability to alter cholesterol levels and promote long-term heart disease.

The relationship between AAS and heart health is complex. Certain steroids are significantly more atherogenic (cholesterol-altering) than others. Some impact LDL ("bad" cholesterol) far more aggressively, while others suppress HDL ("good" cholesterol) to dangerous levels. Others may promote blood pressure increases or direct heart muscle damage.

In this article, we'll explore which steroids have the worst impact on cholesterol and heart health, compare their relative risks, and explain why some users experience more severe cardiovascular consequences than others.

How Anabolic Steroids Impact Heart Health and Cholesterol

Anabolic steroids negatively affect cardiovascular health through multiple, well-studied mechanisms. Their impact goes far beyond simple water retention or mild blood pressure changes.

In fact, certain steroids dramatically alter the body’s lipid profile, impair vascular function, and directly affect the structure of the heart itself. Some of these changes occur rapidly and may persist long after a cycle ends.

Let’s examine the core ways in which anabolic steroids compromise heart health:

1. Reduction of HDL Cholesterol

Virtually all anabolic steroids cause a significant suppression of high-density lipoprotein (HDL) — commonly known as “good” cholesterol. HDL is essential for reverse cholesterol transport, the process by which excess cholesterol is removed from the arteries and returned to the liver for elimination.

Low HDL is strongly linked to an increased risk of atherosclerosis and cardiovascular events.

“AAS use is consistently linked to profound suppression of HDL cholesterol levels—often reducing HDL by 30–70% during a cycle.”
— Kanayama et al., Current Opinion in Endocrinology, Diabetes and Obesity

2. Increase of LDL Cholesterol

Many anabolic steroids — particularly oral 17α-alkylated compounds — also raise low-density lipoprotein (LDL), the "bad" cholesterol that contributes to the buildup of plaques within arteries.

Elevated LDL is a central driver of coronary artery disease. The combination of higher LDL and lower HDL creates a highly atherogenic lipid profile, accelerating cardiovascular risk.

“Oral 17α-alkylated AAS appear especially potent in increasing LDL levels, contributing directly to the development of coronary artery disease.”
— Nieschlag & Vorona, Endocrine Reviews

3. Endothelial Dysfunction

Steroids impair the function of the endothelium, the inner lining of blood vessels responsible for regulating vascular tone and blood flow.

A healthy endothelium maintains vasodilation, reduces inflammation, and prevents blood clots. AAS use promotes endothelial dysfunction, leading to:

Increased arterial stiffness
Reduced ability to dilate blood vessels
A more pro-thrombotic state, raising the risk of clots and stroke

“Endothelial dysfunction associated with AAS use likely contributes to increased arterial stiffness and greater cardiovascular risk.”
— Thompson et al., Journal of Steroid Biochemistry and Molecular Biology

4. Direct Cardiac Effects and Cardiac Remodeling

Beyond cholesterol and vascular effects, anabolic steroids may directly damage cardiac tissue. Steroid use can lead to:

Left ventricular hypertrophy (thickening of the heart muscle)
Myocardial fibrosis (scarring of heart tissue)
Impaired diastolic function (reduced ability of the heart to relax and fill properly)

These changes increase the risk of arrhythmias, heart failure, and sudden cardiac death, especially in users running high-dose or long-term cycles.

“Long-term AAS use is associated with structural and functional alterations of the myocardium, which may contribute to sudden cardiac death in athletes.”
— Baggish et al., Circulation

Which Steroids Cause the Worst Effects on Cholesterol and Heart Health (Ranked Comparison)

Not all anabolic steroids affect heart health equally. Some compounds are highly cardiotoxic, dramatically altering lipid profiles and promoting vascular damage. Others exert milder effects—although no anabolic steroid is truly “safe” for the cardiovascular system.

The greatest cardiovascular risk is typically seen with oral 17α-alkylated steroids, but certain injectable compounds also carry notable dangers.

Below is a ranked comparison of common anabolic steroids and their relative impact on cholesterol and heart health:

1. Superdrol (Methasterone)

Superdrol is among the most cardiotoxic oral steroids in use today. It causes severe HDL suppression and significant LDL elevation—often in as little as 2–4 weeks.

It also increases blood pressure and may promote cardiac hypertrophy at even moderate doses.

“Superdrol exhibits profound hepatotoxicity and induces extreme changes in the lipid profile, rendering it one of the most atherogenic AAS.”
— de Bakker et al., Journal of Clinical Lipidology

2. Winstrol (Stanozolol)

Winstrol is another notorious lipid disruptor. Even low doses of oral Winstrol have been shown to:

Decrease HDL by up to 70%
Increase LDL substantially
Impair endothelial function
Increase arterial stiffness

“Stanozolol has been shown to be one of the most potent AAS in terms of HDL suppression and pro-atherogenic lipid alterations.”
— Glazer, Medicine & Science in Sports & Exercise

3. Anadrol (Oxymetholone)

Anadrol’s impact on cholesterol is severe, similar to Superdrol and Winstrol. Studies report:

Dramatic HDL reductions
Substantial LDL increases
Increased platelet aggregation, raising clotting risk

Additionally, Anadrol may promote direct cardiac remodeling and liver toxicity, compounding its cardiovascular dangers.

“Oxymetholone administration is associated with substantial impairment of lipid metabolism and increased thrombotic potential.”
— Creagh et al., British Journal of Sports Medicine

4. Trenbolone

While Trenbolone is an injectable steroid, it still causes:

Strong suppression of HDL
Mild to moderate elevation of LDL
Significant blood pressure increases
High risk of left ventricular hypertrophy and fibrosis

Its combined effects on blood pressure and cardiac remodeling make it one of the most dangerous steroids for the heart.

“Trenbolone exposure results in adverse changes to the myocardium, blood pressure, and lipid metabolism.”
— Ferenchick, American Journal of Medicine

5. Masteron (Drostanolone)

Masteron causes moderate HDL suppression and minor LDL elevation. Its cardiovascular risk is lower than oral 17α-alkylated steroids, but still present.

HDL reduction is usually around 30–50%
LDL increases are dose-dependent

Masteron’s cardiovascular profile is less severe than Winstrol or Superdrol but not benign.

“Drostanolone, while non-alkylated, still produces significant HDL suppression and modest LDL elevation.”
— Nieschlag & Vorona, Endocrine Reviews

6. Testosterone (All Esters)

Testosterone’s effects on lipids are generally less severe, particularly when used at physiological or slightly supraphysiological doses.

Mild HDL suppression (~10–30%)
Minimal LDL changes
Possible improvement in vascular function if used at TRT doses

However, when used at high bodybuilding doses, testosterone can:

Increase blood pressure
Promote left ventricular hypertrophy
Worsen lipid profiles in combination with aromatization

“Testosterone’s cardiovascular risk is dose-dependent—physiological doses may be neutral or even beneficial, but supraphysiological use promotes adverse lipid changes and cardiac remodeling.”
— Basaria et al., Journal of the American Medical Association

Why Oral Steroids Are More Dangerous Than Injectables for Heart Health

A key pattern emerges when evaluating the cardiovascular risks of anabolic steroids: oral steroids are significantly more damaging to cholesterol and heart health than injectable forms.

This difference is rooted in how oral steroids are chemically modified and metabolized.

1. 17α-Alkylation and Hepatic Metabolism

Oral anabolic steroids are typically modified at the 17α position (17α-alkylation). This chemical change allows the steroid to survive first-pass metabolism through the liver, making it bioavailable when taken orally.

However, this modification also results in greater liver strain and has a pronounced negative effect on lipoprotein metabolism:

Severe HDL suppression is consistently observed with 17α-alkylated oral steroids.
Significant LDL elevation is common, even at modest doses.
The liver’s capacity to clear LDL is impaired.
The production of HDL is suppressed at the gene expression level.

“Oral 17α-alkylated AAS exert disproportionately harmful effects on lipoproteins and liver enzymes compared with injectable steroids.”
— Hartgens & Kuipers, Sports Medicine

2. Bypassing Aromatization and Estrogenic Effects

Many oral steroids are non-aromatizing—they do not convert into estrogen. While this might seem desirable for avoiding gynecomastia, it eliminates the cardioprotective effects of estrogen.

Estrogen is known to:

Increase HDL production
Lower LDL levels
Improve endothelial function

By removing this protective mechanism, oral non-aromatizing steroids (like Winstrol and Superdrol) further tilt the lipid profile toward a pro-atherogenic state.

“Estrogen exerts favorable effects on lipid metabolism and endothelial function; its absence during non-aromatizing AAS use worsens cardiovascular risk.”
— Rosano et al., Circulation

3. Increased Oxidative Stress and Vascular Damage

Oral steroids induce higher levels of oxidative stress than injectables. This stress damages the endothelium and promotes the oxidation of LDL particles—a key step in atherosclerotic plaque formation.

Oxidized LDL is far more atherogenic than native LDL.
Oral AAS increase reactive oxygen species (ROS) within blood vessels.
Endothelial dysfunction is exacerbated.

“Oxidative stress induced by oral AAS plays a central role in endothelial dysfunction and atherosclerotic progression.”
— Ferenchick, American Journal of Medicine

Summary: Why Orals Are Worse

Factor	Oral Steroids	Injectable Steroids
HDL Suppression	Severe	Mild to moderate
LDL Elevation	Severe	Mild
Hepatic Strain	High	Low
Estrogenic Balance	Absent (non-aromatizing)	Present (aromatizable)
Oxidative Stress	High	Moderate

For this reason, cycles built primarily around oral steroids carry the highest cardiovascular risks, especially when run without appropriate countermeasures.

Stacking and Cycle Factors That Increase Cardiovascular Risk

While individual steroids each carry their own cardiovascular risks, the way steroids are combined and cycled can either mitigate or massively exacerbate these dangers.
Many users unknowingly stack compounds in ways that create a perfect storm for heart disease and cholesterol damage.

Here are the most important stacking and cycle factors that impact heart health:

1. Stacking Multiple Oral Steroids

Combining multiple oral 17α-alkylated steroids is one of the most dangerous practices from a cardiovascular standpoint.

Common high-risk combinations include:

Superdrol + Winstrol
Anadrol + Winstrol
Anadrol + Superdrol
Anavar + Winstrol (less severe but still risky)

Each of these combinations leads to:

Additive HDL suppression (often >70–80% reduction)
Massive LDL elevation
Compounded liver strain, further impairing lipid metabolism
Elevated blood pressure and oxidative stress

“Concurrent use of multiple oral AAS results in synergistic worsening of lipid profiles and endothelial function, creating extreme cardiovascular risk.”
— Hartgens & Kuipers, Sports Medicine

2. High-Dose Testosterone Stacks

While testosterone is one of the milder steroids in terms of lipid impact, high doses (>500 mg/week) significantly increase:

Blood pressure
Hematocrit and blood viscosity (raising stroke risk)
Left ventricular mass
Risk of cardiac arrhythmias

When combined with orals or other harsh injectables (such as Trenbolone), this creates a synergistic cardiovascular burden.

“Supraphysiological doses of testosterone combined with other AAS create additive cardiovascular toxicity not seen with TRT doses.”
— Basaria et al., Journal of the American Medical Association

3. Long Cycle Durations

Many users mistakenly run cycles for 16–20 weeks or longer.
Extended exposure to profound HDL suppression and vascular stress allows early atherosclerotic changes to progress rapidly.

Even after the cycle ends, HDL recovery may take 8–12+ weeks—or never fully recover in some cases.

“AAS-induced HDL suppression may persist long after cessation, especially following prolonged cycles with 17α-alkylated compounds.”
— Kanayama et al., Current Opinion in Endocrinology, Diabetes and Obesity

4. Lack of On-Cycle Support

Many users neglect basic cardiovascular support during cycles.
Common mistakes include:

Failing to supplement with omega-3 fatty acids (which improve HDL and reduce inflammation)
Not using Citrulline Malate to support vascular function
→ Swolverine Citrulline Malate
No use of Krill Oil, which is superior to fish oil for improving blood lipids
→ Swolverine Krill Oil
Failing to monitor blood pressure or lipid panels

Simple interventions can blunt some of the cardiovascular harm, but neglecting them makes stacking and long cycles dramatically more dangerous.

How to Protect Heart Health During a Steroid Cycle

If you choose to use anabolic steroids, it’s critical to understand that no cycle is truly cardiovascular safe—but you can take proactive steps to reduce the degree of harm.

Smart supplementation, cardiovascular monitoring, and lifestyle interventions can go a long way in protecting heart health and supporting cholesterol levels during a cycle.

Here are evidence-based strategies:

1. Use Omega-3 and Krill Oil Daily

Omega-3 fatty acids are among the most powerful nutritional tools for improving blood lipids and reducing cardiovascular risk.

They:

Raise HDL levels
Lower triglycerides
Improve endothelial function
Reduce inflammation in the vascular system

For superior potency, Krill Oil offers additional astaxanthin, a potent antioxidant that further protects blood vessels.

→ Swolverine Krill Oil

“Omega-3 fatty acids exert multiple cardioprotective effects, including improvement in lipid profiles and reduction of vascular inflammation.”
— Mozaffarian & Wu, Journal of the American College of Cardiology

2. Support Nitric Oxide and Vascular Function

Maintaining healthy vascular dilation is critical on cycle, as steroids promote arterial stiffness and impair blood flow.

L-Citrulline Malate is one of the best supplements to:

Increase nitric oxide production
Support endothelial function
Improve arterial flexibility
Enhance blood flow and oxygen delivery

→ Swolverine Citrulline Malate

“Citrulline malate supplementation improves endothelial function and may counteract vascular stiffness associated with AAS use.”
— Schwedhelm et al., British Journal of Clinical Pharmacology

3. Limit Oral Steroid Duration and Stack Wisely

If you are using oral steroids such as:

You should:

Keep duration under 4–6 weeks
Never stack multiple orals together
Use injectables like Testosterone Enanthate or Masteron instead of adding orals unnecessarily
If using Trenbolone, be extra vigilant with cardiovascular monitoring

4. Monitor Lipids and Blood Pressure Regularly

You cannot protect what you don’t measure:

Get a lipid panel (HDL, LDL, triglycerides) before, during, and after your cycle
Use a home blood pressure cuff—monitor 2–3 times per week
If HDL drops below 20 mg/dL, or blood pressure exceeds 140/90, cycle adjustments are mandatory

“Close lipid and blood pressure monitoring is essential during AAS use to prevent irreversible vascular damage.”
— Kanayama et al., Current Opinion in Endocrinology, Diabetes and Obesity

5. Incorporate Cardio Into Your Program

While many bodybuilders avoid cardio during bulking phases, it is essential for protecting heart health on cycle:

Perform 20–30 min of moderate cardio 3–5x per week
Activities can include steady-state treadmill walking, cycling, or rowing
Cardio enhances vascular function, reduces blood pressure, and improves lipid profiles

6. Use PCT to Support Recovery

After your cycle, a proper PCT Stack is essential to:

Restore natural testosterone production
Normalize lipid metabolism
Promote cardiovascular recovery

Consider using:

Proper PCT helps accelerate HDL recovery and restore vascular balance.

Nutrition Tips to Support Heart Health During a Steroid Cycle

Your diet plays a critical role in either worsening or helping to offset the cardiovascular risks associated with anabolic steroid use.

Steroids — especially oral AAS — disrupt lipid metabolism and promote systemic inflammation. Targeted nutrition can:

Support HDL recovery
Lower LDL and triglycerides
Improve vascular function
Reduce oxidative stress
Help normalize blood pressure

Here are the most effective dietary strategies to implement during any steroid cycle:

1. Increase Omega-3 Intake

Omega-3 fatty acids from diet and supplementation directly improve lipid profiles and reduce cardiovascular inflammation.

Eat salmon, sardines, mackerel 2–3x/week.
Supplement daily with Krill Oil — superior absorption and additional antioxidants.

→ Swolverine Krill Oil

“Omega-3 fatty acid supplementation significantly improves lipid metabolism and exerts potent anti-inflammatory effects.”
— Mozaffarian & Wu, Journal of the American College of Cardiology

2. Prioritize Antioxidant-Rich Fruits and Vegetables

Oral and injectable steroids increase oxidative stress, damaging blood vessels and promoting LDL oxidation.

Combat this by eating:

Berries (blueberries, raspberries, blackberries)
Citrus fruits
Dark leafy greens
Beets (also support nitric oxide production)
Cruciferous vegetables (broccoli, Brussels sprouts)

These foods provide vitamin C, vitamin E, polyphenols, and flavonoids — all of which help reduce vascular inflammation.

3. Avoid Trans Fats and Limit Saturated Fats

Certain fats dramatically worsen LDL elevation and promote atherogenesis, which is already exacerbated by AAS.

Completely avoid trans fats (partially hydrogenated oils).
Limit butter, cream, and fatty red meats.
Use extra virgin olive oil as your primary fat for cooking.

4. Include Soluble Fiber

Soluble fiber helps bind LDL cholesterol in the gut and promotes its excretion.

Aim for:

Oats
Beans and lentils
Psyllium husk
Ground flaxseed

A simple goal is 25–35g of total fiber per day, with at least 7–10g from soluble fiber.

“Dietary soluble fiber lowers LDL cholesterol by enhancing bile acid excretion and altering cholesterol metabolism.”
— Brown et al., American Journal of Clinical Nutrition

5. Support Nitric Oxide Production Through Food

Steroid use increases arterial stiffness. Supporting nitric oxide helps promote vasodilation and improve blood flow.

Eat foods rich in nitrates and arginine:

Beets
Spinach
Arugula
Watermelon
Pomegranate

Pair this with Citrulline Malate supplementation:

→ Swolverine Citrulline Malate

6. Hydrate Aggressively

Many steroids — particularly Trenbolone and Masteron — can promote fluid shifts and increase blood viscosity.

To combat this:

Drink at least 3–4 liters of water per day.
Include electrolyte-rich beverages (coconut water, LMNT, etc.).
Ensure adequate potassium and magnesium intake to support blood pressure regulation.

If you’re unsure what to eat to protect your heart health while on cycle—or how to structure your nutrition to support lipids, blood pressure, and recovery—don’t guess. Working with an expert coach can make all the difference. At The Swole Kitchen, we build personalized nutrition plans that align with your specific goals and current cycle. Whether you're running Testosterone Enanthate, Trenbolone, or a cutting stack with Masteron and Anavar, we’ll guide you on what to eat, when to eat it, and which supplements to use to help offset cardiovascular risks while maximizing your results. Your heart matters—fuel it right.

Legal Status and Disclaimer

Anabolic steroids are classified as controlled substances in many countries, including the United States, where they are designated as Schedule III drugs under the Controlled Substances Act. Possession or distribution of anabolic steroids without a valid prescription is illegal and may result in serious legal consequences.

Many of the compounds discussed in this article — including Trenbolone, Masteron, Superdrol, Anadrol, and Winstrol — are not legally available for over-the-counter sale and are restricted for medical use only under a licensed healthcare provider’s supervision.

Additionally:

The non-medical use of AAS is associated with a range of serious health risks, including cardiovascular, hepatic, and endocrine complications.
Many black-market steroid products are counterfeit, underdosed, or contaminated, further increasing potential harm.
Users should be aware of local, state, and federal laws governing the possession and use of these substances.

Disclaimer:
This content is for educational and informational purposes only and does not constitute medical advice. The use of anabolic steroids should only be considered under the guidance of a qualified healthcare provider, and always in accordance with applicable laws and regulations. Swolverine does not condone or promote the illegal use of performance-enhancing drugs.

Individuals concerned about safe performance enhancement, recovery, or body composition are encouraged to explore legal, clinically supported options such as:

Cardarine (GW501516)
MK-677 (Ibutamoren)
BPC-157 and TB500 for joint and muscle recovery
DHEA to naturally support hormonal balance

Conclusion: Which Steroids Should You Avoid for Cardiovascular Safety?

When it comes to cardiovascular risk, not all steroids are created equal. Some compounds pose extreme danger to heart health, while others are comparatively less harmful — though no anabolic steroid is entirely safe.

Based on the evidence:

The worst offenders for HDL suppression, LDL elevation, and vascular damage include:
→ Superdrol
→ Winstrol
→ Anadrol
Injectables like Trenbolone also carry significant heart risks, particularly regarding blood pressure and cardiac remodeling.
Even milder options such as Masteron, Anavar, and high-dose Testosterone Enanthate must be used cautiously if heart health is a priority.

If you choose to run a cycle:

✅ Favor injectables over orals
✅ Limit cycle length and stacking complexity
✅ Support your cardiovascular system with:
→ Krill Oil
→ Citrulline Malate
✅ Monitor lipids and blood pressure consistently
✅ Follow a cardioprotective diet or get expert guidance through The Swole Kitchen

If you're unsure what to eat or how to support your heart during your cycle, the coaching team at The Swole Kitchen can help. We’ll create a targeted nutrition plan to support your goals while helping you navigate the cardiovascular risks of steroid use.

Above all: remember that your heart is not replaceable. Pursue your physique goals intelligently—and never sacrifice long-term health for short-term gains.

Tags: Anabolics