Researchers at the University of Leeds have found that those prescribed low doses of steroids, often to combat inflammatory diseases, are at an increased risk of cardiovascular diseases. The team’s findings, published this month in PLOS Medicine, reveal that doses of steroids previously considered to be safe long term may actually pose serious health risks to those taking them.
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High doses of glucocorticoids linked with cardiovascular disease, low doses not well studied
Immune-mediated inflammatory disease (IMID) refers to a group of disorders defined by chronic inflammation of organs or systems caused by an altered immune regulation. The umbrella of IMID covers disorders such as colitis, Crohn's disease, psoriasis, psoriatic arthritis, rheumatoid arthritis, and spondyloarthritis. Around 3-7% of the world’s population suffers from an IMID, having a significant impact on public health and global healthcare systems.
Steroids known as glucocorticoids are commonly prescribed to treat a wide range of IMIDs. While medical professionals have long understood the relationship between high doses of glucocorticoids and an increased risk of cardiovascular disease (CVD), the relationship between low doses and such a risk has been less studied.
Generally, the low doses prescribed to patients with IMIDs have been considered safe, however, empirical evidence of this is lacking. Scientists at the University of Leeds, UK, saw the need to investigate how low doses of glucocorticoid impact a person’s risk of CVD.
Just 5mg of glucocorticoid almost doubles the chances of CVD
The UK-based researchers designed a study to quantify glucocorticoid dose-dependent cardiovascular risk. They obtained and analyzed the medical records of a total of 87,794 patients who had a diagnosis of one of six different IMIDs. All patients were receiving care within 389 primary care units in the UK between 1998 and 2017.
The study’s results showed that patients who were prescribed less than 5 mg of glucocorticoid daily were at almost double the risk of developing CVD in comparison with patients not taking glucocorticoids. This dose increased patients’ risk of all measured CVDs, such as abdominal aortic aneurysm, acute myocardial infarction, atrial fibrillation, cerebrovascular disease, heart failure, and peripheral arterial disease.
Doses of 5mg or less of glucocorticoid were previously considered to be safe even when taken long-term. The current study contradicts this commonly held belief, demonstrating that these low doses can dramatically increase a patient’s risk of CVD, with just 5mg doubling a person’s chances of developing such a disease.
The findings are crucial for the future treatment of patients with IMIDs. It suggests that physicians should always prescribe the lowest effective dose and that personalized prevention plans may be vital to protecting patients from an unnecessarily elevated risk of CVD.
Monitoring IMID patients for risk of CVD
Our findings highlight the importance of implementing and evaluating targeted intensive cardiovascular risk factor modification interventions; promptly and regularly monitor patient cardiovascular risk, beyond the diagnosis of inflammatory arthropathies and systemic lupus erythematosus, even when prescribing low prednisolone-equivalent doses”.
For the first time, the scientific community has evidence that those receiving any dose of steroids, not just high doses, face an increased risk of developing a range of CVDs. The results of the current study also demonstrate that this risk increases with the dose and duration of treatment.
Importantly, the study provides evidence against the previously held belief that low doses did not carry risks to cardiovascular health as did large doses. This carries significant implications for the treatment of patients with IMIDs, who are doubly likely to develop CVD than the general population.
This research highlights the need for research and development into new, long-term treatments for IMIDs that have a better safety profile.
- Pujades-Rodriguez M, Morgan AW, Cubbon RM, Wu J (2020) Dose-dependent oral glucocorticoid cardiovascular risks in people with immune-mediated inflammatory diseases: A population-based cohort study. PLoS Med 17(12): e1003432. https://doi.org/10.1371/journal.pmed.1003432