Corticosteroid-induced lipodystrophy is associated with features of the metabolic syndrome

Familial and HIV-associated lipodystrophies are associated with metabolic disorders and elevated blood pressure. Whether corticosteroid-induced lipodystrophy (CIL) is also associated with features of the metabolic syndrome is unknown.

We conducted a prospective study in two French tertiary centres and enrolled all consecutive patients starting long-term (> or = 3 months), high dosage (> or = 20 mg/day) systemic corticosteroid therapy. Three investigators assessed the development of CIL from standardized head and neck photographs. Arterial blood pressure and fasting blood glucose levels were assessed at baseline and then every three months until month 12. Total, HDL- and LDL-cholesterol and triglycerides were recorded at baseline, month 3 and month 12.

Eighty-eight patients were enrolled (women: 75%, mean age: 57.4 +/- 17.9 yrs, mean baseline dosage of prednisolone: 56 +/- 15 mg/day). Sixty-four patients still received corticosteroids at month 12 (mean prednisolone dosage: 11 +/- 4 mg/day). In intention-to-treat analysis, the cumulative incidence rate of CIL at months 3 and 12 was 61 +/- 8% and 69 +/- 9%, respectively. Baseline characteristics were similar in patients who developed CIL and patients who did not develop CIL during follow-up except with regard to baseline body mass index, which was higher in patients who develop CIL (24.3 +/- 3.7 kg/m2 vs 21.4 +/- 3.2 kg/m2, P= 0.02). Blood pressure was significantly higher in CIL+ patients at month 9 (135/78 mmHg vs 127/73 mmHg) and month 12 (141/81 mmHg vs 128/72 mmHg) visits. Moreover, compared with CIL- patients, CIL+ patients had significantly higher plasma concentrations of fasting blood glucose, triglycerides and total cholesterol and lower HDL-cholesterol concentration during follow-up.

CIL is associated with features of the metabolic syndrome and should then not be considered only as an aesthetic challenge. Further studies are required to test the relation between CIL and cardiovascular events.