ABSTRACT Background Androgen abuse among young men is a prevalent yet under recognized risk factor for atherosclerotic cardiovascular disease (ASCVD). Supraphysiological androgen exposure adversely affects lipoprotein profiles, blood pressure, and vascular function, potentially accelerating atherosclerosis even in otherwise healthy individuals. Conventional cardiovascular risk prediction models may underestimate risk in this population due to fluctuating biomarker profiles and other unaccounted risk‐increasing factors that are not captured in these models. Objectives To review the mechanisms by which androgen abuse contributes to ASCVD, to highlight limitations of traditional risk stratification tools in this population, and to propose tailored approaches to risk assessment and prevention. Methods Narrative review of epidemiological, imaging, and mechanistic studies examining cardiovascular risk factors and subclinical atherosclerosis in androgen abusers. Results Available evidence indicates that androgen abuse adversely affects lipid profiles, blood pressure, and vascular endothelial function, and is associated with increased subclinical atherosclerosis. Conventional risk prediction models may underestimate risk in this population due to young age, fluctuating biomarker profiles, and cumulative exposure effects not captured by standard algorithms. Conclusions Androgen abuse should be recognized as a cardiovascular risk‐enhancing factor in young men. Individualized risk assessment beyond traditional calculators may be warranted to guide preventive strategies in selected patients.
Bond et al. (2026) studied this question.