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. A study published in PLOS Medcine by Mar Pujades-Rodriguez at Leeds University and colleagues suggests that even low doses of glucocorticoid may increase the risk of cardiovascular diseases.
To quantify glucocorticoid dose-dependent cardiovascular risk, researchers analyzed medical records of 87,794 patients diagnosed with 6 different immune-mediate inflammatory diseases receiving care from 389 United Kingdom primary care clinics in 1998-2017. The researchers found that for patients using less than 5 miligrams prenisolone per day, the absolute risk of cardiovascular disease nearly doubled compared to patients not using glucocorticoids (Hazard Ratio = 1.74; 95% confidence interval 1.64-1.84). Increased dose-dependent risk ratios were found across all CVDs measured, including atrial figrillation, heart failure, acute myocardial infarction, peripheral arterial disease, cerebrovascular disease, and abdominal aortic aneurysm.
Previously, it was believed that taking 5 mg of glucocorticoid over the long-term was safe, but the study suggests that even patients taking low doses have double the risk of developing cardiovascular disease. These findings suggest patients needing long-term steroid treatment should be prescribed the lowest effective dose and have a personalized cardiovascular risk prevention plan that accounts for past and current steroid use. Although the study was limited by the lack of available hospital data on prescription drug adherence and may have reduced the size 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 highlight the importance of implementing and evaluating targeted intensive cardiovascular risk factor modification interventions; promptly and regularly monitor patient cardiovascular risk, beyond diagnosis of inflammatory arthropathies and systemic lupus erythematosus, even when prescribing low prednisolone-equivalent doses".
Peer reviewed; Observational study; Humans
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Funding: A.W.M. is supported by the Medical Research Council TARGET Partnership Grant (Treatment According to Response in Giant cEll arTeritis) (MR/N011775/1) and the National Institute for Health Research (NIHR) Medtech and In vitro Diagnostics Co-operatives at Leeds (MIC-2016-015). A.W.M. and J.W. are supported by the NIHR Biomedical Research Centre at Leeds (IS-BRC-1215-20015). The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Dr. AWM reports grants from Medical Research Council, grants from National Institute for Health Research, during the conduct of the study; grants and personal fees from Roche/ Chugai, personal fees from Sanofi, personal fees from GlaxoSmithKline, personal fees from Regeneron, outside the submitted work. Dr. MPR is currently employed by IQVIA (start of contract >1 year after completing and submitting this work). It is not possible to spell out IQVIA because there is no long form for it: https:/
Citation: Pujades-Rodriguez M, Morgan AW, Cubbon RM, Wu J (2020) Dose-dependent oral glucocorticoid cardiovascular risks in people with immune-mediated inflammatory diseases: A population-based cohort study. PLoS Med 17(12): e1003432. https:/