Low Dose Corticosteroid Use Associated With Cardiovascular Side Effects

Long term, high-dose Corticosteroid use has always been liked with the risk of cardiovascular diseases, however, a new Leeds University study shows that the same risk may be present even with low-dose corticosteroid use.

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What are corticosteroids?

Corticosteroids, more commonly known as steroids, belong to the anti-inflammatory drug class and are commonly prescribed for immune-mediated inflammatory disorders like Asthma, rheumatoid arthritis, lupus, or vasculitis.

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Corticosteroids are synthetic analogs of steroid hormones produced in the adrenal gland of the human body. They reduce inflammation and swelling in the body along with the activity of the immune system, just like the naturally produced hormones in the body.

Although they have several benefits, long term use of high dose corticosteroids is associated with an increased risk of cardiovascular diseases. However, a recent study shows that this increased risk may also be present with the consumption of low-dose corticosteroids.

The Leeds University Study

A new study published in the PLOS Medicine Magazine by Pujades-Rodriguez, Wu, and their team from the Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds was performed with the objective of determining dose-dependent oral glucocorticoid cardiovascular risks in people with six immune-mediated inflammatory conditions.

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Method of Study

For this study, Pujades-Rodriguez and his team performed a population-based cohort analysis of medical records from 389 medical centers and primary care offices, to analyze the cumulative glucocorticoid prednisolone-equivalent dose-related risks and hazard ratio of cardiovascular disease.

The cases included in this cohort all met the inclusion eligibility criteria indicating that they were at least 18 years of age, had no cardiovascular disease, and were diagnosed with at least one of the six immune-mediated inflammatory diseases for which they were taking oral glucocorticoids.

The team of researchers used the United Kingdom Clinical Practice Research Datalink (CPRD) to obtain the necessary data to reach conclusive results about the use of low dose corticosteroids increased the risk of cardiovascular conditions.

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Results of Study

The study focused on 87,794 adults all of whom were diagnosed with either vasculitis, lupus, giant cell arteritis, polymyalgia, inflammatory bowel disease, and/or rheumatoid arthritis. After careful statistical analysis of the cases and the follow-up, researchers found that the risk of cardiovascular diseases was almost double in those taking glucocorticoids, even if less than 5 mg was used than in non-users.

Wu and his team also mention that these increased risk percentages and hazard ratios differed for each inflammatory condition and the most common cardiovascular diseases due to corticosteroid use were found to be myocardial infarction and atrial fibrillation. They also noted that the risk increase was higher with chronic or long-term inflammatory conditions.

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Basically, the risk of cardiovascular diseases is present with even low dose use of corticosteroids, for any of the six inflammatory diseases. Pudeja-Rodrigues, Wu, and their team, after analyzing the results of the study, strongly advise that only the lowest effective dose of corticosteroids be prescribed and that these patients follow-up with cardiologists and follow a cardiac care plan to minimize the risk of cardiovascular diseases.

The team of researchers also recommends that this glucocorticoid dose-dependent cardiovascular risk be further investigated to publish clear guidelines for the future prescription of this class of drugs to patients with an inflammatory condition.

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References

Dose-dependent oral glucocorticoid cardiovascular risks in people with immune-mediated inflammatory diseases: A population-based cohort study

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