Glucocorticoids have adverse systemic effects, including obesity, hypertension, and hyperglycemia, that may predispose to cardiovascular disease.
The effect of glucocorticoid use on cardiovascular disease has not been quantified.
Dr Wie, Dr MacDonald and Dr Brian Walker undertook a study in order to test the hypothesis that users of exogenous glucocorticoids have an increased risk for cardiovascular disease.
The researchers designed a cohort study using a record linkage database from Tayside in Scotland.
The research team included 68 781 glucocorticoid users and 82 202 nonusers without previous hospitalization for cardiovascular disease.
The participants were studied between 1993 and 1996.
The researchers categorized the average daily dose of glucocorticoid exposure during follow-up as low (inhaled, nasal, and topical only), medium (oral, rectal, or parenteral <7.5 mg of prednisolone equivalent), or high (7.5 mg of prednisolone equivalent).
The research team then calculated the association bewteeen glucocorticoid exposure and cardiovascul;ar outcome using a poisson regression model, sensitivity analysis, and propensity score methods.
|Relative risk for a cardiovascular event in patients receiving high-dose glucocorticoids was 2.56|
|Annals of Internal Medicine|
The researchers found that 4383 cardiovascular events occurred in 257 487 person-years of follow-up for a rate of 17.0 per 1000 person-years in the comparator group.
In addition, 5068 events occurred in 212 287 person-years for a rate of 23.9 per 1000 person-years in the group exposed to glucocorticoids (22.1, 27.2, and 76.5 in low, medium, and high groups, respectively).
The team calculated the absolute risk difference as 6.9 per 1000 person-years (5.1, 10.1, and 59.4, respectively).
After adjustment for known covariates, the researchers found that the relative risk for a cardiovascular event in patients receiving high-dose glucocorticoids was 2.56.
The group commented that because the data were observational, residual confounding could not be excluded.
Dr Wei, speaking on behalf of the research team concluded, "Treatment with high-dose glucocorticoids seemed to be associated with increased risk for cardiovascular disease."