Glucocorticoid Medications and the Risk for Cardiovascular Disease

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.

The summary below is from the full report titled "Taking Glucocorticoids by Prescription Is Associated with Subsequent Cardiovascular Disease." It is in the 16 November 2004 issue of Annals of Internal Medicine (volume 141, pages 764-770). The authors are L. Wei, T.M. MacDonald, and B.R. Walker.

What is the problem and what is known about it so far?

Glucocorticoids (also known as steroids or corticosteroids) include medications such as beclomethasone, prednisone, prednisolone, cortisone, and hydrocortisone. Glucocorticoids are related to corticosteroid hormones produced by the adrenal glands. Doctors prescribe glucocorticoids primarily to treat inflammatory conditions that affect the lungs, skin, joints, digestive tract, eyes, or other body systems. Common diseases that frequently require treatment with glucocorticoids include asthma, inflammatory bowel disease, and some types of arthritis. Glucocorticoids generally do not cause serious side effects when patients use them in small amounts or for short durations. However, patients who require high doses or longer duration of glucocorticoid treatment can develop side effects, including weight gain, mood changes, high blood pressure, high blood sugar levels, and thinning of the bones. Some people worry that glucocorticoids' effects on blood pressure, blood sugar, and body weight put users at high risk for cardiovascular disease, such as heart attack and stroke. While glucocorticoids have been associated with higher risk for cardiovascular disease, research on the existence and strength of the link between glucocorticoids medications and cardiovascular disease is limited.

Why did the researchers do this particular study?

To study the relationship between glucocorticoid medications and cardiovascular disease.

Who was studied?

68,781 people who used glucocorticoids and 82,202 who had not. Study participants resided in Tayside, Scotland, and were registered in a National Health Service database from 1993 to 1996.

How was the study done?

The researchers used information in the database to calculate the average daily dose of glucocorticoid medications given by mouth, by inhalation, or by application on the skin over the study period. They converted the amounts of different glucocorticoids into an equivalent dose of prednisolone to make comparisons easier. They also used the database to determine whether patients had had a cardiovascular event, such as a heart attack or stroke. The researchers then examined the relationship between glucocorticoid use and cardiovascular events while controlling for other factors that might influence cardiovascular disease.

What did the researchers find?

Patients who received high-dose glucocorticoids were more than twice as likely to have had a cardiovascular event as patients who used no glucocorticoids. They defined high-dose glucocorticoid use as the equivalent of 7.5 mg of prednisolone per day or more during 1 to 5 years of follow-up. Lower doses were not associated with an increase in cardiovascular events.

What were the limitations of the study?

This study did not definitively determine that glucocorticoids themselves, not the diseases that had necessitated treatment with high-dose glucocorticoid treatment, accounted for the higher risk for cardiovascular disease.

What are the implications of the study?

Patients receiving high-dose glucocorticoids seem to have an increased risk for cardiovascular events than patients who do not use glucocorticoids. Patients and doctors should consider this risk when they weigh the benefits and risks of glucocorticoid treatment.