Endocrine Abstracts

Context: Glucocorticoids have adverse systemic effects which may predispose to cardiovascular disease. The effect of glucocorticoid use on cardiovascular disease has not been assessed.
Objective: To test the hypothesis that users of exogenous glucocorticoids have a dose-dependent increased risk of cardiovascular disease; in particular, that supraphysiological doses will be associated with cardiovascular disease.
Design: A cohort study using a record linkage database.
Setting: The population of Tayside, Scotland.
Patients: The study cohort consisted of 76203 subjects aged >= 40 years who received one or more prescriptions for a glucocorticoid between 1st July 1993 and 31st December 1996. These were subdivided into those exposed to subphysiological (inhaled and topical only), ~ physiological (oral, rectal or parenteral < 7.5mg prednisolone-equivalent per day), and supraphysiological (>=7.5 mg prednisolone-equivalent per day). The comparator cohort consisted of 87930 subjects aged >= 40 years who did not receive glucocorticoids during the same period.
Outcome measures: Cardiovascular events defined as a hospitalisation with a primary diagnosis of myocardial infarction (MI), angina, angioplasty, coronary revascularisation, congestive cardiac failure, stroke, transient ischemic attack (TIA) or cardiovascular death during the follow-up period.
Results: There were 7029 cardiovascular events in 366475 person-years (PY) of follow-up, or 19.2 per 1000 PY (95% CI 18.7-19.6), in the comparator group and 7490 events in 230711 PY, or 32.5 per 1000 PY (31.7-33.2), in the group exposed to glucocorticoids (31.1, 34.1 and 102.5 in subphysiological, ~ physiological and supraphysiological groups, respectively). The relative risk of a cardiovascular event in patients receiving supraphysiological doses after adjustment for known covariates was 2.70, (95% CI 2.33-3.13). Analysis of individual outcomes showed that supraphysiological glucocorticoid exposure was associated with congestive cardiac failure (4.21, 3.12-5.66), MI (3.07, 2.46-3.84) and stroke or TIA (1.93, 1.41-2.64).
Conclusions: Treatment with glucocorticoids was associated with dose-related increased risk of cardiovascular disease.