Low-dose steroids almost double risk of cardiovascular disease

Patients treated with glucocorticoids are at increased risk of cardiovascular disease (CVD), research suggests.
Prednisolone

Patients treated with glucocorticoids, even at doses as low as 5mg daily, are at increased risk of cardiovascular disease (CVD), research in PLOS Medicine has suggested (3 December 2020)​1​.

Scientists examined data collected between 1998 and 2017 for 87,794 patients in the UK with at least one of six common immune-mediated inflammatory diseases.

They found that the overall risk of CVD almost doubled in patients taking less than 5mg prednisolone per day, compared with periods of non-glucocorticoid use (hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.64–1.84).

In patients taking the equivalent of 25mg prednisolone or more per day, the one-year cumulative risks of all-cause CVD were six times higher than during periods of non-use (8.9% compared with 1.4%). Five-year cumulative risks were 28.0% compared with 7.1% during periods of non-use.

Risk increased with the dose of glucocorticoid for all CVDs measured, and regardless of the type of disease or level of disease activity.

“Our findings highlight the importance of implementing and evaluating targeted intensive cardiovascular risk factor modification interventions; promptly and regularly monitor patient cardiovascular risk, beyond diagnosis of inflammatory arthropathies and systemic lupus erythematosus, even when prescribing low prednisolone-equivalent doses,” the researchers concluded.

  1. 1.
    Pujades-Rodriguez M, Morgan AW, Cubbon RM, Wu J. Dose-dependent oral glucocorticoid cardiovascular risks in people with immune-mediated inflammatory diseases: A population-based cohort study. Rahimi K, ed. PLoS Med. Published online December 3, 2020:e1003432. doi:10.1371/journal.pmed.1003432
Last updated
Citation
The Pharmaceutical Journal, PJ, March 2021, Vol 306, No 7947;306(7947)::DOI:10.1211/PJ.2021.1.893