The Pharmaceutical Journal
Vol 270 No 7242 p429
29 March 2003

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Society for Endocrinology (www.endocrinology.org)

Steroid link with increased heart disease should not alarm patients

Asthma patients "should not be alarmed" about the results of a study linking steroid use with an increased risk of heart disease.

So says one of the study's authors Professor Brian Walker, endocrinology unit, Western General Hospital, Edinburgh, who presented the findings at a meeting of the British Endocrine Societies earlier this week.

Using prescription information from Tayside, Scotland, his group identified patients over 40 years of age receiving glucocorticoid therapies from July 1993 to December 1996. Some 76,000 patients were found and matched with around 88,000 controls.

There were 32.5 cardiovascular events per 1,000 person years in the steroid group, compared with 19.2 per 1,000 person years among the controls. Events included myocardial infarction, angina, heart failure and stroke. For those on doses equivalent to or greater than 7.5mg prednisolone per day, the figure was 102.5 events per 1,000 person years. After adjustment for confounding factors, the relative risk of a cardiac event with high-dose steroid was found to be 2.7. The high doses were linked with heart failure, heart attack and stroke.

Professor Walker told The Journal that pharmacists might expect these results, knowing that high doses of oral steroids can lead to obesity and diabetes — both risk factors for heart disease. "However we have not known the magnitude of risk," he said, adding that there had been some suggestion that steroids protected blood vessel walls, reducing occlusion.

Urging caution Professor Walker said: "These drugs are effective in the treatment of certain conditions, particularly asthma. The overall benefits of treatment with glucocorticoids outweigh the risks for most patients. However, this study alerts doctors to be cautious when using high doses for extended periods, especially in patients already considered to be at a greater risk of cardiovascular disease, such as those with diabetes."

Commenting on the findings, Professor Martyn Partridge, chief medical adviser, National Asthma Campaign, said: "It is important to note that any perceived risk for those with asthma is with steroid tablets, and at high doses and over a long period.

"It is also important to realise that such population studies do need to be interpreted with great care. There have been previous studies suggesting that those with asthma have a higher risk of heart disease and closer inspection has shown that you have only to erroneously include a few people with smoking induced chronic obstructive pulmonary disease (who are treated with the same drugs) and misclassify them as asthma to get a spurious answer regarding risk of heart disease."