Taking Glucocorticoids by Prescription Is Associated with Subsequent Cardiovascular Disease

Li, Wei; MacDonald, Thomas M.; Walker, Brian R.

doi:10.7326/0003-4819-141-10-200411160-00007

Cited by 639 publications

(431 citation statements)

References 28 publications

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“…In the study by Wei et al (38), there was no statistically significant association between glucocorticoids and CV events for the subset with inflammatory bowel disease, indicating that the overall findings did not necessarily apply to all patient subgroups. Similarly, data from our group (41) suggested that in polymyalgia rheumatica, cumulative glucocorticoid exposure is not associated with an increased risk of CV events and, in fact, may be protective.…”

Section: Discussionmentioning

confidence: 87%

“…Wei et al (38) recently reported on 60,000 glucocorticoid users and 80,000 nonusers that high-dose exposure (Ͼ7.5 mg/day) was associated with a 3-fold increased risk of CV events, after propensity score matching for comorbidities and medications. Within a subset of patients with inflammatory arthritis (defined according to the use of DMARDs), high-dose exposure was associated with a 5-fold increased risk of CV events.…”

Section: Discussionmentioning

confidence: 99%

“…Wei et al (38) and Souverein et al (40) examined large study populations of Ͼ50,000 subjects, which included all glucocorticoid users in the general population. Bernatsky et al (39) also had a large study cohort consisting of all RA patients and with diagnoses classified by diagnostic codes.…”

Section: Discussionmentioning

confidence: 99%

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Glucocorticoids and cardiovascular events in rheumatoid arthritis: A population‐based cohort study

Davis¹,

Kremers²,

Crowson³

et al. 2007

Arthritis & Rheumatism

220

122

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Objective. To determine the relationship between glucocorticoid exposure and cardiovascular (CV) events in patients with rheumatoid arthritis (RA).Methods. A total of 603 adult residents of Rochester, Minnesota with incident RA between 1955 and 1995 were followed up through their medical records for a median of 13 years (total of 9,066 person-years). Glucocorticoid exposure was defined 3 ways: tertiles of cumulative exposure; recent use (<3 months) versus past use (>3 months); and average daily dosage (<7.5 mg/day or >7.5 mg/day). CV events, including myocardial infarction, heart failure, and death from CV causes, were defined according to validated criteria. Cox regression models were adjusted for demographic features, CV risk factors, and RA characteristics.Results. Rheumatoid factor (RF)-negative patients with exposure to glucocorticoids were not at increased risk of CV events, irrespective of the glucocorticoid dosage or timing of use, as compared with the reference group of RF-negative patients who had never been exposed to glucocorticoids. In contrast, RFpositive patients were at increased risk of CV events, particularly with higher cumulative exposure, higher average daily dosage, and recent use of glucocorticoids. RF-positive patients with high cumulative exposure to glucocorticoids had a 3-fold increased risk of CV events (hazard ratio 3.06 [95% confidence interval 1.81-5.18]), whereas RF-negative patients with high cumulative exposure were not at increased risk (hazard ratio 0.85 [95% confidence interval 0.39-1.87]).Conclusion. RF-positive but not RF-negative patients were at increased risk of CV events following exposure to glucocorticoids. These findings suggest that glucocorticoids interact with RF status to modulate the occurrence of CV events in patients with RA. The mechanisms underlying this interaction are unknown and should be the subject of further research.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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Glucocorticoids and cardiovascular events in rheumatoid arthritis: A population‐based cohort study

Davis¹,

Kremers²,

Crowson³

et al. 2007

Arthritis & Rheumatism

220

122

View full text Add to dashboard Cite

show abstract

“…Whilst the short-term benefits of elevated glucocorticoid levels are self-evident, in the long term, elevated blood levels of glucocorticoids whether extreme, as in Cushing's Disease or pharmacological, following prescription usage of glucocorticoids, have deleterious sideeffects, including hypertension, insulin resistance and increased cardiovascular disease risk (Souverein et al, 2004;Wei et al, 2004). Because of the striking phenotypic similarities between Cushing's Syndrome and Metabolic Syndrome, it was proposed that in the absence of excessive blood glucocorticoid levels, elevated intracellular levels of glucocorticoids through increased activity of 11β-HSD1, especially in adipose tissue, might be causative in Metabolic Syndrome .…”

Section: β-Hsd1 As a Therapeutic Targetmentioning

confidence: 99%

The role and regulation of 11β-hydroxysteroid dehydrogenase type 1 in the inflammatory response

Chapman

Coutinho

Gray

et al. 2009

Molecular and Cellular Endocrinology

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“…Their numerous adverse effects include hyperglycaemia, osteoporosis, opportunistic infections, proximal myopathy, glaucoma and cataracts, and the detrimental effects on cardiovascular health as documented in observational studies. 10,11 A major problem associated with the use of highdose corticosteroids is the changes in mental state -mood swings, agitation, insomnia and rarely psychosis.…”

Section: Corticosteroidsmentioning

confidence: 99%

Inflammatory Bowel Disease in Older People

Grimpen¹,

Pavli

2008

Pharmacy Practice and Res

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Inflammatory bowel disease (IBD) can affect patients of all ages. The majority of patients are diagnosed in the second or third decade of life, but a minority develop the disease at an advanced age. Diagnosis can be delayed due to the preconception that IBD mainly affects young people, and the broader spectrum of differential diagnoses in the elderly. Management and treatment options are similar to those in younger patients but adverse reactions and drug interactions may be of greater significance in the elderly. Precluding treatment with anti-tumour necrosis factor drugs on grounds of previous infection with tuberculosis or viral hepatitis, comorbidities or previous malignancy -factors often found with advanced age -can make treatment challenging. The increased risk of bowel cancer in IBD warrants regular screening, especially in the elderly as their absolute risk of cancer is higher.

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Taking Glucocorticoids by Prescription Is Associated with Subsequent Cardiovascular Disease

Abstract: Treatment with high-dose glucocorticoids seemed to be associated with increased risk for cardiovascular disease.

Cited by 639 publications

References 28 publications

Glucocorticoids and cardiovascular events in rheumatoid arthritis: A population‐based cohort study

Glucocorticoids and cardiovascular events in rheumatoid arthritis: A population‐based cohort study

The role and regulation of 11β-hydroxysteroid dehydrogenase type 1 in the inflammatory response

Inflammatory Bowel Disease in Older People

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