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Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 11: Drugs and Performance-Enhancing Substances: A Scientific Statement From the American Heart Association and American College of Cardiology.

The use of performance-enhancing drugs and substances, or doping, is one of the most important and difficult challenges in contemporary sports. Doping occurs when a prohibited substance or its metabolite is documented in a bodily specimen or when a prohibited method is used to increase athletic performance.1 Most commonly, the substances or methods used for doping have not been evaluated for therapeutic use. The abuse of counterfeit or designer drugs that are not regulated is a particular threat to the athlete’s health. Doping also threatens the integrity of sport. The use of artificial enhancements to gain an advantage over others in competition is fundamentally unfair to athletes who train and compete by the rules.

Athletic governing organizations maintain updated lists of prohibited substances.2 The prohibition of these agents is based on preventing an unfair athletic advantage and eliminating the health risks of doping. Generally, these drugs fall into categories that include anabolic agents, hormones and related substances, β2-adrenergic agonists, stimulants, and diuretic agents.1,2 Multiple masking agents are also prohibited because they are used to hide or prevent detection of a banned substance.1,2 Drugs used for enhancement of oxygen transfer, such as erythropoietin, or techniques of autotransfusion are also prohibited.1,2 Many drugs and substances considered “recreational” rather than performance enhancing, including narcotics, cannabinoids, and alcohol, are also prohibited.1,2

Of the many adverse effects of performance-enhancing substances, those that affect the cardiovascular system are among the most serious and will be the focus of this document.3 This section also summarizes the best available, albeit limited, data on the adverse cardiovascular effects of prohibited substances in athletes. In addition, strategies for effective implementation of antidoping programs will be discussed, and specific recommendations for healthcare professionals will …