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Glucocorticoid Use Tied to CVD Risk in Immune-Mediated Diseases

MONDAY, Dec. 7, 2020 -- For patients with six immune-mediated inflammatory diseases, the risk for cardiovascular disease (CVD) is increased in association with glucocorticoid dose, according to a study published online Dec. 3 in PLOS Medicine.

Mar Pujades-Rodriguez, Ph.D., from the University of Leeds in the United Kingdom, and colleagues aimed to quantify glucocorticoid dose-dependent CVD risk among 87,794 individuals with immune-mediated inflammatory diseases (giant cell arteritis and/or polymyalgia rheumatica, inflammatory bowel disease, rheumatoid arthritis, systemic lupus erythematosus, and/or vasculitis).

The researchers found that 15.3 percent of people had incident CVD. There was an increase in one-year cumulative risks for all-cause CVD from 1.4 percent in periods of nonuse to 8.9 percent for a daily prednisolone-equivalent dose of ≥25.0 mg. The corresponding five-year cumulative risks increased from 7.1 to 28 percent. Those with a daily prednisolone-equivalent dose <5.0 mg had increased all-cause CVD risk compared with periods of nonglucocorticoid use (hazard ratio, 1.74; range, 1.52 for polymyalgia and/or giant cell arteritis to 2.82 for systemic lupus erythematosus). For daily dose use <5.0 mg, the hazard ratios for type-specific cardiovascular disease were 1.69, 1.75, 1.76, 1.78, 1.32, and 1.93 for atrial fibrillation, heart failure, acute myocardial infarction, peripheral arterial disease, cerebrovascular disease, and abdominal aortic aneurysm, respectively.

"The elevated absolute risk of CVD in patients receiving high doses of glucocorticoids, of similar magnitude to that of patients with diabetes or established CVD, warrants the need to implement and evaluate intensive lifestyle modification interventions to this high-risk group," the authors write.

One author disclosed financial ties to the pharmaceutical industry; a second author disclosed ties to IQVIA.

Abstract/Full Text

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Posted: December 2020

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