A new study published in theJournal of American Medical Associationshowed that both men and women should be the focus of preventative interventions against the use of androgenic anabolic steroids (AAS) in recreational sports, since cumulative lifetime exposure to these drugs was an independent risk linked to coronary atherosclerosis and myocardial dysfunction in both sexes. Recreational athletes frequently use AAS illegally, but there are little data on the negative effects of AAS usage on the cardiovascular system, particularly in female users. Thus, to compare the cardiovascular state of Danish male and female recreational athletes who use AAS to those who do not, this study was carried out. Recreational athletes who were 18 years of age or older and active AAS users, previous users (defined as those who stopped using AAS at least three months prior to the study), or nonusers were recruited from fitness centers between March and December 2022 for this cross-sectional study in a single center in Denmark. The presence of atherosclerosis (carotid, femoral, and coronary artery plaques) and echocardiography-measured heart function were the main outcomes. Regression coefficients for echocardiographic features were estimated using linear regression, and odds ratios (ORs) for carotid and femoral plaques, coronary artery calcium (CAC) scores, and coronary noncalcified plaques (NCPs) were estimated using logistic regression. 80 (48.8%) of the 164 individuals, who were primarily men (76.2%) and had a median age of 35, were actively using AAS. 58 (35.4%) had never used AAS, whereas 26 (15.9%) had previously used it. For both current and past users, the median length of time spent using steroids was 2.2 years. There were no discernible differences between the groups in terms of coronary artery calcium (CAC) scores or the occurrence of femoral or carotid artery plaques. However, compared to nonusers, active users were more likely to have coronary non-calcified plaques (NCPs). Longer lifetime AAS usage was associated with a higher risk of coronary NCPs and a positive CAC score, according to adjusted analysis. More severe calcifications were associated with use longer than 5 years. Furthermore, echocardiography showed that in the majority of long-term users, increased cumulative AAS exposure was linked to aberrant ventricular mass and compromised heart function. Overall, athletes who had been exposed to AAS for more than 5 years had more severe calcification, and cumulative lifetime exposure was linked to negative cardiovascular results and reduced ventricular function in both sexes. Buhl, L. F., Christensen, L. L., Hjortebjerg, R., Hasific, S., Hjerrild, C., Harders, S., Lillevang-Johansen, M., Glintborg, D., Andersen, M. S., Thevis, M., Kistorp, C., Rasmussen, J. J., Lindholt, J. S., Diederichsen, A. C. P., & Frystyk, J. (2025). Illicit anabolic steroid use and cardiovascular status in men and women. JAMA Network Open, 8(8),.https://doi.org/10.1001/jamanetworkopen.2025.26636