whoa whoa, do you mean this would prevent/reverse the heart concern (left ventricle hypertrophy, i think?)? Why isn't it more popular? I've always considered that heart hypertrophy the scariest of all aas sides!
Any medication that controls blood pressure (an inotrope) and to a lesser extent pulse rate (a chronotrope) while on AAS will reduce or prevent left ventricular hypertrophy (LVH) - this includes diuretics, beta blockers, alpha blockers, calcium channel blockers, ACE inhibitors as well as ARBs. But LVH in itself is not necessarily an issue. It often reflects the fact that bodybuilders have developed the significantly superior heart function and strength required to shift large weights and feed powerful muscles - what would be called an 'athletic' adaptation.
The problem is when this coincides with fibrosis in cardiovascular tissues. In this instance fibrosis is the deposition of less flexible collagen not just in the heart but in arteries and veins across the body. This seems to occur directly and indirectly as a result of AAS use, and some AAS are worse than others - eg Deca is notoriously bad. This extra collagen makes the cardiovascular tissues a bit 'stiffer' and increases the pressure (force) required by the heart to pump blood through the body (increases the 'load').
As a result, a rather less healthy (and structurally maladaptive) deposition of new muscle (LVH) will occur in an attempt to overcome the strain of the increasing load, and once past a certain size, it begins to reduce the efficiency of the heart as a pump. But the fibrosis also affects things like the passage of nerve impulses across the heart (often resulting in atrial fibrillation or heart block, for example), and interferes with the essential growth of new blood vessels (angiogenesis) to the new cardiac muscle, potentially starving these tissues of oxygen, resulting in pain (angina), necrosis and scarring. And the scarring makes the heart even more inflexible, and is thus basically a very unwelcome positive feedback loop.
All these outcomes are incredibly unhealthy for the heart, and probably explain why some powerlifters/bodybuilders (anecdotally, and I suppose relative to their otherwise incredibly healthy looking bodies) seem to suffer disproportionately from heart attacks, afib etc etc. ARBs are unusual in their ability to reverse tissue fibrosis, and as a bonus can also reduce blood pressure, which is a major trigger for unhealthy LVH. N-acetylcysteine has potentially been shown to have benefits in reducing fibrosis, but these unfortunately cancel out those of the ARB!
** As for why it's not more popular... beats me! I've been banging on about this for at least 10+ years. Usually I'm met with silence and confusion (out of ignorance I suppose) and also wails of 'polypharmacy' - by men otherwise pumping themselves full of dozens of 'unnecessary' compounds. To each their own.
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