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The role of glucocorticoids in increasing cardiovascular risk
Hai-Wei Deng1,2, Wei-Yi Mei1,2, Qing Xu1,2
1Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Insights
Glucocorticoids (GCs) increase the risk of major adverse cardiovascular events (MACE), coronary heart disease (CHD), and heart failure (HF). The risk escalates with higher cumulative or daily GCs dosage, highlighting a significant cardiovascular concern.
Area of Science:
- Cardiology
- Pharmacology
- Epidemiology
Background:
- Conflicting evidence exists regarding glucocorticoid (GC) use and cardiovascular disease (CVD) risk.
- Understanding this association is crucial for patient management and risk stratification.
Purpose of the Study:
- To systematically review and meta-analyze the correlation between GC use and cardiovascular risk.
- To assess the impact of GCs on major adverse cardiovascular events (MACE), coronary heart disease (CHD), heart failure (HF), stroke, and all-cause mortality.
Main Methods:
- Comprehensive literature search conducted in PubMed and Embase up to June 1, 2022.
- Inclusion of 43 studies encompassing 15,572,512 subjects.
- Meta-analysis of relative risk (RR) estimates and 95% confidence intervals (CIs) for cardiovascular outcomes.
Main Results:
- GC use was associated with a higher risk of MACE (RR=1.27), CHD (RR=1.25), and HF (RR=1.92).
- MACE risk increased with cumulative and daily GC doses.
- An absolute increase of 13.94 MACE cases per 1,000 person-years was observed with GC use.
Conclusions:
- GC administration is linked to an elevated risk of MACE, CHD, and HF.
- The cardiovascular risk associated with GCs appears dose-dependent.
- No significant association was found between GC use and increased all-cause death or stroke.
Introduction:
Different studies provide conflicting evidence regarding the potential for glucocorticoids (GCs) to increase the risk of cardiovascular diseases. This study performed a systematic review and meta-analysis to determine the correlation between GCs and cardiovascular risk, including major adverse cardiovascular events (MACE), death from any cause, coronary heart disease (CHD), heart failure (HF), and stroke.
Methods:
We performed a comprehensive search in PubMed and Embase (from inception to June 1, 2022). Studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the associations of interest were included.
Results:
A total of 43 studies with 15,572,512 subjects were included. Patients taking GCs had a higher risk of MACE (RR = 1.27, 95% CI: 1.15-1.40), CHD (RR = 1.25, 95% CI: 1.11-1.41), and HF (RR = 1.92, 95% CI: 1.51-2.45). The MACE risk increased by 10% (95% CI: 6%-15%) for each additional gram of GCs cumulative dose or by 63% (95% CI: 46%-83%) for an additional 10 μg daily dose. The subgroup analysis suggested that not inhaled GCs and current GCs use were associated with increasing MACE risk. Similarly, GCs were linked to an increase in absolute MACE risk of 13.94 (95% CI: 10.29-17.58) cases per 1,000 person-years.
Conclusions:
Administration of GCs is possibly related with increased risk for MACE, CHD, and HF but not increased all-cause death or stroke. Furthermore, it seems that the risk of MACE increased with increasing cumulative or daily dose of GCs.
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