Short-term dose and duration-dependent glucocorticoid risk for cardiovascular events in glucocorticoid-naive patients with rheumatoid arthritis
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  • Published on:
    Correspondence on “Short-term dose and duration-dependent glucocorticoid risk for cardiovascular events in glucocorticoid-naïve patients with rheumatoid arthritis” by Ocon et al.
    • Tsung-Kun Lin, Professor School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
    • Other Contributors:
      • Lung-Fa Pan, Professor
      • Gwo-Ping Jong, Professor

    We read with great interest the article by Ocon et al.,1 which reported that daily doses of ≥5 mg of prednisone-equivalents, elevated cumulative dose and extended duration of use of glucocorticoid (GC) over the preceding six-month and one-year intervals are associated with an increased risk for incident cardiovascular event (CVE) in steroid-naïve patients with rheumatoid arthritis (RA). Additionally, they also noted that no association with risk for CVE was found with daily prednisone of ≤4 mg or shorter cumulative doses and durations. This study is a valuable addition to the literature. However, some issues have not been addressed by the authors.
    First, metabolic syndrome and its components could mediate and may be causal in the association between CVE in RA and use of GC in the dose ranges and duration of use, which may offset the significance level.2 3 Additionally, a mediation analysis could have been used to address this mediation effect. Although metabolic syndrome and its severity can be identified and controlled, the likelihood of future metabolic syndrome complications cannot be assessed in most cases. However, the baseline metabolic syndrome data of the two groups were not available in this study. It is important to consider the context of metabolic syndrome when evaluating CVE for glucocorticoid-naïve patients with RA who initiate ‘low-dose’ GC over short-term intervals of use.
    Second, a family history of cardiovascular disease is a strong risk facto...

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    Conflict of Interest:
    None declared.