In Part 2 of this series on PEDs and steroids, Cardiologist Professor Peter Barlis discusses the direct and indirect effects of these agents on heart health. Over time, steroids cause cellular changes to the heart muscle known as cardiac remodeling. This process occurs as a result of the increased work the heart needs to do to cater for the increasing muscle mass within the body and the increasing and often vigorous training it is put under. Cardiovascular complications of steroids go beyond just the changes observed due to lowered ‘good’ cholesterol and higher ‘bad’ cholesterol, there are changes causing high blood pressure, increased rhythm disturbances, obstructive sleep apnea, congestive cardiac failure and risk of sudden death. Careful monitoring of heart health remains paramount if a decision is made to utilize any of these performance enhancing substances and it is crucial these are monitored by a qualified healthcare professional. All information is presented for general and educational purposes.