Glucocorticoids are steroids widely prescribed to treat a range of immune-mediated inflammatory diseases. While high doses of steroids are known to increase the risk of cardiovascular disease, the impact of lower doses is unknown. One study suggests that even low doses of glucocorticoids can increase the risk of cardiovascular disease.
The study led by Mar Pujades-Rodriguez at the University of Leeds and colleagues was published in PLOS Medicine.
To quantify the dose-dependent cardiovascular risk of glucocorticoids, researchers analyzed medical records of 87,794 patients diagnosed with 6 different immune-mediated inflammatory diseases who received care from 389 primary care clinics in the United Kingdom in 1998-2017.
The researchers found that for patients who took less than 5 milligrams of prednisolone per day, the absolute risk of cardiovascular disease almost doubled compared to patients who did not use glucocorticoids (Hazard Ratio = 1.74; 95 percent confidence interval 1.64-1 , 84).
Increased dose-dependent risk ratios were found in all cardiovascular diseases measured, including atrial fibrillation, heart failure, acute myocardial infarction, peripheral arterial disease, cerebrovascular disease and abdominal aortic aneurysm.
It was previously believed to be safe to take 5 mg of glucocorticoid over the long term, but the study suggests that even patients taking low doses have a double risk of developing cardiovascular disease. These findings suggest that patients requiring long-term steroid treatment should receive the lowest effective dose and have a personalized cardiovascular risk prevention plan that takes into account past and present steroid use. While the study was limited by the lack of available hospital data on prescription drug adherence and may have reduced the magnitude of dose-response estimates, the authors believe that the large sample size contributes to greater generalizability of the results.
According to the authors, “our findings underscore the importance of implementing and evaluating targeted intensive interventions for cardiovascular risk factors; monitor the patient’s cardiovascular risk immediately and regularly, in addition to diagnosing inflammatory arthropathies and systemic lupus erythematosus, even when prescribing low prednisolone equivalent doses. “
(This story was published from a wire agent feed with no changes to the text.)
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