Erythropoiesis stimulating agents and sport: From the theoretical oxigen delivery enhancement to possible clinical cardiac issues

In many sport disciplines the delivery of oxygen to muscles plays a critical role. In late 1980s recombinant Erythropoietin became available for the treatment of anaemia and the first studies showed that this hormone was able to induce an increase in the total body hemoglobin with a coupled profound effect on exercise tolerance. Ten years later it became clear that recombinant erythropoietin was the preferred drug for those athletes seeking to artificially enhance their endurance performances. The use of this hormone causes many very well documented side effects. Additional clinical issues should be raised when considering the potential cardiac side effects of the use of erythropoiesis stimulating agents. With this regard, an increasing number of cardiovascular deaths in athletes have been reported by different authors. However, information about the cardiovascular risk profile of competitive athletes are still poor, in particular when considering a concomitant use of erythropoiesis stimulating agents.