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GLASGOW (Reuters Health) Mar 24 - People on long-term treatment
with high doses of anti-inflammatory steroids are up to three times
as likely to develop heart disease than those who never take the
drugs, Scottish researchers reported on Monday.
Professor Brian R. Walker from the University of Edinburgh
and colleagues used a database of prescriptions given to 164,000
Scots over the age of 40 to measure the cardiovascular risks linked
to corticosteroids.
Doctors are well aware that the significant benefits
of the drugs against diseases like asthma and arthritis are accompanied
by side effects that include obesity, diabetes and high blood pressure--all
of which also increase the risk of heart disease.
But it is important to quantify this risk and know
whether there is a dose threshold at which the effect would occur,
Professor Walker told Reuters Health ahead of the British Endocrine
Society meeting in Glasgow where the results were presented.
Nearly half of the study population had received at
least one dose of steroids in the course of the 4-year study period.
About 2% of the population were receiving significant oral doses--more
than 7.5 milligrams of prednisolone or the equivalent daily.
For those who were not prescribed the drugs, the cardiovascular
event rate was 19.2 per 1000 person-years, Professor Walker reported.
For those exposed to steroids of any variety, that risk increased
to 32.5 per 1000 persons-years.
"The worst case scenario are those who are exposed
to the highest doses for the longest period and in that group, the
relative risk is approaching 3 to 1," Professor Walker told Reuters
Health. "These individuals might have a risk as high as 1-in-2 of
an event over a 10-year follow-up period."
"How worried should those people be? Provided that
their doctor has a good reason to be treating them then it's a matter
of balancing up these risks against the benefits," the researcher
said. People with life-threatening asthma or debilitating rheumatoid
arthritis might consider the risks worth taking, he said.
"It does mean that we should be emphasising to doctors
that they should be paying attention to cardiovascular risk," he
added. "It is arguable given this information that we should be
even more aggressive about treating blood pressure, lipids and diabetes
in patients taking steroids."
At the other end of the scale, the researchers found
no evidence of increased risk in people taking inhaled steroids
for asthma or steroid creams for conditions like dermatitis.
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