giphy.com
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A study involving 88,000 people showed that even low doses of the steroid hormones glucocorticoids (less than five milligrams per day) increase the risk of cardiovascular disease in patients with immune-inflammatory diseases. how report scientists in PLOS Medicine, the risk of developing these diseases in patients taking less than five milligrams of prednisolone per day doubled within a year, and in patients taking 25 milligrams of prednisolone or more per day, it increased sixfold over the same period. Low doses of glucocorticoids were previously thought to be safe in the long term.
Patients with immune-inflammatory diseases, as a rule, receive courses of glucocorticoids – strong hormonal anti-inflammatory drugs. It is already known that long-term treatment with glucocorticoids can to raise the risk of cardiovascular diseases due to the aggravation of the metabolic syndrome and mineralocorticoid effectsleading to violations of water and electrolyte balance. However, there is evidence that the anti-inflammatory and immunosuppressive effects of glucocorticoids help reduce the severity of atherosclerotic lesions in chronic inflammatory diseases.
In addition, the relationship between glucocorticoid dose and cardiovascular disease researched, basically, excluding doses or other drugs previously received by a person, and also excluding others risk factors for cardiovascular disease (eg, smoking). Mar Pujades-Rodriguez of the University of Leeds attempted to assess the dose-dependent risks of oral glucocorticoids in people with immunoinflammatory diseases.
The study included almost 88,000 adults who, for an average of 9.5 years, suffered from at least one immune-inflammatory disease: giant cell arteritis, inflammatory bowel disease, rheumatoid arthritis, vasculitis and systemic lupus erythematosus. Arterial hypertension (25.1 percent), asthma (14.6 percent) and diabetes (6.4 percent) were the most frequent comorbidities in patients. The average age of the patients was 56 years, and 34.1 percent of men and 24.2 percent of women smoked at the time of the study.
In the year before the start of follow-up, 16.4 percent of patients took oral glucocorticoids, 15.2 percent – inhaled or nasal glucocorticoids, and 45.2 percent – non-steroidal anti-inflammatory drugs. Given the differences in the relative anti-inflammatory effects of different types of glucocorticoids, the researchers converted the dose to the equivalent of prednisolone.
On average, one patient was followed up for five years. During this time, doctors diagnosed 15.3 percent of patients with acute disorders of the cardiovascular system (atrial fibrillation, heart failure, and myocardial infarction).
The incidence of cardiovascular disease within one year increased from 1.4 percent (for the period without glucocorticoids) to 3.8 percent for low doses (less than 5 milligrams) and to 8.9 percent for a daily dose of ≥ 25 milligrams. On average, low doses of glucocorticoids increased the risk of developing cardiovascular disease by 74 percent. The scientists also found that the dose-related effects were more pronounced in men.
Overall, an increase in glucocorticoid dose of five milligrams increases the risk of developing cardiovascular disease by an average of eight percent – from seven percent for inflammatory bowel disease to 30 percent for systemic lupus erythematosus. The relationship remained statistically significant when considering the side variables (age, smoking, sex, blood biochemical parameters, etc.).
Although the researchers found only an association between glucocorticoid use and an increased risk of cardiovascular disease in patients with immunoinflammatory diseases, new evidence suggests a rethinking of the previously held belief that low-dose glucocorticoids are safe in the long term. It may be necessary to develop new approaches to the treatment of immuno-inflammatory diseases, and patients requiring long-term treatment with these drugs should be prescribed the lowest effective dose.
However, there are many benefits from glucocorticoids. One of them – dexamethasone – by a third lowered mortality of patients with COVID-19 on mechanical ventilation, and in developing countries he succeeded reduce neonatal mortality.
Vyacheslav Gomenyuk
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