Long-Term Steroids Increase Heart Risk

LONDON (Reuters Health) - 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.

Professors Tom MacDonald from the University of Dundee and Brian Walker from the University of Edinburgh 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 was important to quantify this risk and know whether there was a dose threshold at which the effect would occur, 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 four-year study period, they found. About 2 percent of the population were getting significant oral doses--more than 7.5 milligrams of prednisolone or equivalent a day.

For those who were not prescribed the drugs, the cardiovascular risk equated to 19 out of 1000 people being hospitalized for heart attack, angina, heart surgery, stroke or other cardiovascular problem in the course of a year, Walker reported.

For people exposed to steroids of any variety, that risk increased to 32 per 1000 people per year.

"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," Walker told Reuters Health. "These individuals might have a risk as high as one-in-two 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 emphasizing 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 antiinflammatory steroid creams for conditions like dermatitis.

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