Use of oral corticosteroids and the risk of acute myocardial infarction
Introduction
Acute and chronic inflammation plays a role in the pathophysiology of atherosclerosis. Corticosteroids are considered the gold standard for anti-inflammatory treatment. However, the use of oral corticosteroids is associated with cardiovascular adverse effects including dyslipemia, hypertension and glucose intolerance [1]. These effects might predispose treated patients to coronary heart disease (CHD). Both prolonged administration and high-doses of corticosteroids have been reported to accelerate atherosclerosis, although studies evaluating surrogates markers of atherosclerosis have shown conflicting results [2], [3], [4].
Oral corticosteroids are commonly used in the treatment of chronic obstructive pulmonary disease (COPD), asthma, lupus erythematosus, rheumatoid arthritis and organ transplantation. The impact of oral corticosteroids on the cardiovascular system has been documented in patients with these conditions [5], [6], [7], [8]. Despite their widespread use, few epidemiological studies have examined the risk of cardiovascular diseases (CVD) associated with corticosteroids. These studies suggest an increased risk of CVD associated to the use of high doses of corticosteroids [9], [10].
Therefore, we have estimated the effect of oral corticosteroid use, dose, and duration on the risk of acute myocardial infarction (AMI), and examined if this risk is modified by prior history of CHD, arthritis, COPD or asthma, and other risk factors or selected comedications.
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Population
We conducted this study in the general population in the United Kingdom covered through the general practice research database (GPRD). The GPRD contains computerized medical information entered systematically by general practitioners (GPs) in the UK and sent anonymously to the Medicines and Healthcare products Regulatory Agency (MHRA). [11] Recorded information includes demographic data, outpatient clinical diagnoses, consultant referrals and hospital admissions, and prescriptions. More than
Results
We included 4795 cases of AMI and 20,000 controls. A majority (65%) were men, 55% were aged 70 years or older, and 44% were fatal cases (n = 1914). A total of 743 (15%) cases and 2364 (12%) controls had ever used oral corticosteroids, and 198 (4%) and 507 (3%) were current users, respectively. Because cases and controls were frequency matched by age and sex, the distribution of characteristics only in the control population according to exposure status is provided in Table 1. Current-users were
Discussion
Oral corticosteroids are widely used in the UK over a broad range of indications for varying duration of time [18]. The prevalence of use in the overall GPRD population has been reported close to 1% although varies substantially with age.
In our study, current use of oral corticosteroids was associated with a modest increase in the risk of fatal and non-fatal AMI. This increased risk was mainly observed during the first month of treatment and was dose-dependent. Use of daily prednisolone
Acknowledgment
We thank the general practitioners for their excellent collaboration and the Boston Collaborative Drug Surveillance Program for providing access to the General Practice Research Database.
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