Background Glucocorticoid exposure is associated with a two- to threefold increased risk of cardiovascular events [1, 2]. There are reasonable clinical and biological bases to hypothesize that this risk is higher in glucocorticoid-exposed people who develop lipodystrophy than in glucocorticoid-exposed patients without lipodystrophy.
Objectives To assess the incidence rates of cardiovascular events in people prescribed systemic glucocorticoids and with a diagnosis of glucocorticoid-induced lipodystrophy (GCs+GIL+) by comparison to two comparison population, i.e., people prescribed systemic glucocorticoids with no diagnosis of glucocorticoid-induced lipodystrophy (GCs+GIL–) and people not prescribed systemic glucocorticoids (GCs–). To assess the association between lipodystrophy and the risk of cardiovascular events.
Methods The Health Improvement Network primary care database was used to identify the three study populations. Cox proportional hazards models were used to estimate hazard ratios associated with lipodystrophy.Models were adjusted for sex, age, duration of glucocorticoid exposure, underlying disease, smoking status and past history of antidiabetic, antihypertensive or lipid lowering drug prescription.
Results 547 GCs+GIL+ people were compared to 3231 GCs+GIL- people and to 3282 GCs- people. 417 cardiovascular events (coronary heart disease n=239, heart failure n=112, ischemic stroke n=66) occurred within a year after diagnosis of lipodystrophy or after a randomly selected date in 341 patients. Taking into account only the first event by patient, the incidence rates of cardiovascular event per 100 person-year at risk were 15.1 (95% confidence interval, 11.8 to 18.4), 6.4 (5.5 to 7.3) and 4.1 (3.4 to 4.8), respectively in GCs+GIL+, GCs+GIL– and GCs– groups. By comparison to GCs+GIL– people, those in the GCs+GIL+ group had a nearly three fold increased risk of cardiovascular events (adjusted hazard ratios: 2.27 (1.48 to 3.47) for coronary heart disease, 3.77 (2.41 to 5.90) for heart failure and 2.23 (0.96 to 5.17) for ischemic cerebrovascular events). The adjusted hazard ratio for any cardiovascular event was 4.16 (2.98 to 5.82) when the GCs+GIL+ group was compared to the GCs– group
Conclusions In glucocorticoid-exposed patients, lipodystrophy should be aggressively targeted for early screening and management of atherosclerosis and other cardiovascular risk factors.
Souverein PC, Berard A, Van Staa TP, Cooper C, Egberts AC, Leufkens HG et al. Use of oral glucocorticoids and risk of cardiovascular and cerebrovascular disease in a population based case-control study. Heart. 2004;90:859-65
Wei L, MacDonald TM, Walker BR. Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease. Ann Intern Med. 2004;141:764-70
Disclosure of Interest None Declared
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