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Glucocorticoids are steroids widely prescribed to treat a number of immune-mediated inflammatory diseases. Although 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 of the University of Leeds and colleagues suggests that even low doses of glucocorticoids can increase the risk of cardiovascular disease.
To quantify the dose-dependent cardiovascular risk of glucocorticoids, the researchers analyzed medical records of 87,794 patients diagnosed with 6 different immune-mediated inflammatory diseases who received treatment from 389 UK primary care clinics in 1998-2017. The researchers found that for patients using less than 5 milligrams of 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 in all cardiovascular diseases measured, including atrial drilling, heart failure, acute myocardial infarction, peripheral arterial disease, cerebrovascular disease, and abdominal aortic aneurysm.
Previously, it was believed that taking long-term 5 mg of glucocorticoids was safe, but the study suggests that even patients taking low doses have double the risk of developing cardiovascular disease. These findings suggest that patients requiring long-term steroid treatment should be prescribed the lowest effective dose and have a personalized cardiovascular risk prevention plan that takes into account 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 results highlight the importance of implementing and evaluating targeted interventions for intensive modification of cardiovascular risk factors; promptly and regularly monitoring the patient’s cardiovascular risk, as well as diagnosing inflammatory arthropathies and systemic lupus erythematosus, even when low equivalent doses of prednisolone are prescribed. “
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