High-dose steroids up heart disease risk greatly

Treatment with high doses of medicinal steroids (aka, glucocorticoids) more than doubles the risk of cardiovascular disease, new research suggests.

Many people have to take steroid drugs - for example, by inhaler to treat asthma or in lotion form for skin allergies, while others need to take the drugs by injection or as pills to treat inflammatory condition like arthritis.

These agents are known to produce side effects, such as obesity, high blood pressure, and high blood sugar levels, which can lead to heart disease.

Glucocorticoids given by injection or in oral form (termed systemic therapy) confer a higher risk of side effects, while non-systemic therapy using inhalers and lotions has a lower risk - but the actual risk had not been quantified.

To investigate, Dr. Thomas M. MacDonald, from the Ninewells Hospital and Medical School in Dundee, Scotland, and colleagues compared cardiovascular events among 68,781 glucocorticoid users and for 82,202 non-users.

At the start of the study, none of the subjects had been hospitalized for heart disease or stroke. Over the study period a period, the rate of cardiovascular events in the glucocorticoid group was 23.9 per 1000 persons per year - higher than the rate of 17.0 per 1000 per year seen in the non-user group.

For participants who took the highest doses of glucocorticoids, the rate was much higher - 76.5 per 1000 persons per year, the researchers report in the Annals of Internal Medicine.

However, most of the danger was tied to systemic therapy. "Most patients exposed to glucocorticoids received only non-systemic glucocorticoids, and these prescriptions were not associated with a measurable increase in rates of cardiovascular disease," the team points out.

SOURCE: Annals of Internal Medicine, November 16, 2004.