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Time and dose-dependent effect of systemic glucocorticoids on major adverse cardiovascular event in patients with
Ho So1, Tsz On Lam1, Huan Meng1
1Department of Medicine & Therapeutics, The Chinese University, Hong Kong, Hong Kong.
Insights
Glucocorticoid (GC) use in rheumatoid arthritis (RA) patients increases cardiovascular event risk, particularly at daily doses of 5mg or higher. Lower GC doses (<5mg daily) did not significantly elevate cardiovascular risk in this study.
Area of Science:
- Rheumatology
- Cardiology
- Pharmacology
Background:
- Rheumatoid arthritis (RA) patients face elevated cardiovascular event (CVE) risk.
- Glucocorticoid (GC) use is a known contributor to CVE risk in RA, but a clear dose-response threshold remains debated.
Purpose of the Study:
- To investigate the time-varying effect of glucocorticoid (GC) dose and duration on the risk of major adverse cardiovascular events (MACE) in rheumatoid arthritis (RA) patients.
- To determine if a specific threshold of GC use increases MACE incidence.
Main Methods:
- Retrospective cohort study of 12,233 RA patients from a Hong Kong database (2006-2018).
- Time-varying Cox regression and inverse probability treatment weighting analyses were employed.
- Adjustments were made for demographics, traditional cardiovascular risk factors, inflammatory markers, and antirheumatic drug use.
Main Results:
- A total of 860 (7.0%) of 12,233 RA patients experienced MACE over 105,826 patient-years.
- Daily prednisolone doses ≥5 mg significantly increased MACE risk (HR 2.02-2.37), whereas doses <5 mg did not.
- Each additional month of daily prednisolone ≥5 mg was associated with a 7% increase in MACE risk.
Conclusions:
- Glucocorticoid use in RA patients is associated with a duration- and dose-dependent increase in MACE risk.
- Very low-dose daily prednisolone (<5 mg) does not appear to confer significant additional cardiovascular risk.
Objectives:
Cardiovascular event (CVE) risk in rheumatoid arthritis (RA) was increased by glucocorticoids (GC) use. Whether there is a threshold dose and duration of GC use beyond which will increase CVE rate remains controversial. We studied the time-varying effect of GC and its dose on the risk of incident major adverse cardiovascular events (MACE) in patients with RA.
Methods:
Patients with RA without MACE at baseline were recruited from a Hong Kong citywide database from 2006 to 2015 and followed till 2018. The primary outcome was the first occurrence of an MACE. Cox regression and inverse probability treatment weighting analyses with time-varying covariates were used to evaluate the association of GC and MACE, adjusting for demographics, traditional CV risk factors, inflammatory markers and the usage of antirheumatic drugs.
Results:
Among 12 233 RA patients with 105 826 patient-years of follow-up and a mean follow-up duration of 8.7 years, 860 (7.0%) developed MACE. In the time-varying analyses after controlling for confounding factors, a daily prednisolone dose of ≥5 mg significantly increased the risk of MACE (erythrocyte sedimentation rate model: HR 2.02, 95% CI 1.72 to 2.37; C reactive protein model: HR 1.87, 95% CI 1.60 to 2.18), while a daily dose below 5 mg was not associated with MACE risk, compared with no GC use. In patients receiving daily prednisolone ≥5 mg, the risk of incident MACE was increased by 7% per month.
Conclusions:
GC was associated with a duration and dose-dependent increased risk of MACE in patients with RA. Very low dose prednisolone (<5 mg daily) did not appear to confer excessive CV risk.
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