SELECTED ARTICLES FROM THE RECENT LITERATURE 2004
12/9/04
Corticosteroid therapy associated with increased risk of
cardiovascular disease
Summary
Background - A number of adverse side effects of chronic therapy with oral corticosteroids (CS) have been identified. However, the risk for cardiovascular disease in such CS-treated patients has not been quantitated
Findings - Wei et al of the Nine wells Hospital and Medical School in Dundee, Scotland carried out a cohort observational study, using a record linkage database of an adult population in Scotland. They found a prevalence of cardiovascular (CV) disease events of 17/1000patient years in those not receiving CS. In comparison, the prevalence of CV events was: 1) 22 in those received only inhaled, nasal and topical CS; 2) 27 in those received the equivalent of <7.5mg prednisone/day by oral, rectal or injected routes and 3) 77 in those receiving a 7.5 mg prednisone/day. The relative risk (RR) for a CV event in those receiving a 7.5 mg prednisone/day was 2.6.
Reference
Annals of Intern Med 2004;141:764-770 Editor's Comments
Although this retrospective observational analysis had the usual limitations of this type of study (including residual confounding factors), the data do strongly suggest an increased risk for CV events in those receiving the equivalent of a 7.5 mg prednisone/day for a sizable duration of time. The question remains whether the increased CV risk is a direct effect of the CS therapy or characteristics of patients who require such systemic CS therapy. It's true that patients with a variety of disease being treated with CS were included in this analysis. I have reviewed this report because many patients with severe asthma are treated with systemic CS in doses of a 7.5 mg of prednisone (or equivalent). It is encouraging that the risk for CV events appear only modestly increased in those receiving CS by the inhaled and intranasal routes only. Obviously, every effort should be made to keep any systemic steroid use to the minimum amount needed for asthma control.
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