Corticosteroid Use Hikes CV Risks in Rheumatic Patients Save

UK Clinical Practice Research Datalink population study shows that patients with immune-mediated inflammatory diseases, such as rheumatoid arthritis, polymyalgia rheumatica, giant cell arteritis, and inflammatory bowel disease, have an augmented risk of cardiovascular (CV) outcomes with glucocorticoid use; even lower doses (<5 mg of prednisone per day) had a near doubling of their underlying CVD risk.

It is long known that high-dose steroids may increase the risk of cardiovascular disease (CVD), heart disease, stroke, or other vascular outcomes, but it is unknown what the risk is at lower doses. 

Researches utilized the UK Practice Research Datalink (CPRD), and identified 87,794 IMID patients (without prior CVD) that included patients with giant cell arteritis and/or polymyalgia rheumatica (n = 25,581), inflammatory bowel disease (n = 27,739), rheumatoid arthritis (n = 25,324), systemic lupus erythematosus (n = 3,951), and/or vasculitis (n = 5,199). The mean age was 56 years, 34% were men and the median follow-up time was 5 years. Many of these patients had modifiable cardiovascular risk factors, including current smoking (24%), obesity (25%), or hypertension (25%).

They conducted a population-based cohort analysis of medical records from 389 primary care practices in the UK, looking at 6 common CVD outcomes, including myocardial infarction, heart failure, atrial fibrillation, and cerebrovascular disease.

Incident CVD occurred in 15%), including 6,013 atrial fibrillation, 7,727 heart failure, and 2,809 acute myocardial infarction events.

One-year cumulative risks of all-cause CVD increased from 1.4% in periods of non-use to 8.9% for a daily prednisolone-equivalent dose of ≥25.0 mg.

Five-year cumulative risks increased from 7.1% to 28.0%, respectively.

Even <5.0 mg daily prednisolone-equivalent dose had increased all-cause CVD risk (HR = 1.74; 95% confidence interval [CI] 1.64–1.84) compared to non-use.

Increased dose-dependent risk ratios were found regardless of disease activity level and for all type-specific CVDs.

In this study, we observed an increased risk of CVDs associated with steroid use with a 1 year CVD risk that doubled for individuals using less than 5 mg prednisolone per day and was 6 times higher for users of 25 mg per day or higher.  CV risk can be modified by limiting steroid exposure in IMID patients.