Steroids Linked to Higher Heart Disease Risk

Taking high doses of steroids (glucocorticoids) seems to increase the risk of heart disease including heart attack, heart failure, and stroke, according to new research.

Steroids fight inflammation and are often prescribed for conditions including asthma, inflammatory bowel disease, and inflammatory arthritis. Prednisone and hydrocortisone are two examples of steroids.

Yet well-known adverse effects of these potent anti-inflammatory medications can increase the risk of developing high blood pressure, diabetes, and obesity -- risk factors for heart disease.

What is less well known about these drugs is whether and to what extent steroids contribute to heart disease and heart disease death. They write this is not predictable since these medications have anti-inflammatory effects on blood vessels -- inflammation of blood vessels has been found to be a key mediator of atherosclerosis.

The new study conducted by researcher Thomas MacDonald, MD, FRCPE, of Scotland’s Ninewells Hospital and Medical School appears in the Nov. 16 issue of the journal Annals of Internal Medicine.

MacDonald and colleagues examined medical record data from more than 68,000 people with steroid prescriptions and about 82,000 people not taking steroids.

All patients were at least 40 years old when the data was collected by Scotland’s National Health Service from 1993 to 1996.

Steroid types, doses, and length of treatment varied, so the researchers calculated equivalent doses for comparison. The scientists tracked participants’ “cardiovascular events” including heart attack, heart failure, and stroke.

Heart disease risk was more than 2.5 times higher in people taking high doses of steroids compared with those not taking steroids.

“Treatment with high-dose glucocorticoids seemed to be associated with an increased risk for cardiovascular disease,” write the researchers.

Patients taking the equivalent of 7.5 milligrams of prednisolone per day had “substantially higher rates of all cardiovascular diseases” during one to five years of follow-up, write the researchers.

Patients taking low doses of steroids fared better. They had a similar risk for heart disease as those not taking steroids.

However, the researchers don’t say steroids cause cardiovascular disease, since other factors may have been at work. They could not establish whether the disease, for which treatment with steroids was necessary, account for the higher risk of heart disease in this group of individuals.

For instance, the scientists didn’t have information on the patients’ disease severity, smoking, obesity, exercise, and diet, although they tried to adjust for at least some of those factors.

By Miranda Hitti, reviewed by Brunilda Nazario, MD

SOURCES: Wei, L. Annals of Internal Medicine, Nov. 16, 2004; vol 141: pp 764-770. “Summaries for Patients,” Annals of Internal Medicine, Nov. 16, 2004; vol 141: p I-58. WebMD Medical Reference from Healthwise: “Corcticosteroids (Glucocorticoids) for Cancer and Cancer Pain.”