Use of oral corticosteroids and the risk of acute myocardial infarction.
BACKGROUND
A few epidemiological studies suggested an increased coronary heart disease (CHD) risk with high doses of oral corticosteroids.


METHODS
We performed a cohort study with nested case-control analysis to estimate the risk of acute myocardial infarction (AMI) associated with the use of oral corticosteroids by dose and duration. We followed-up 404,183 persons, 50-84 years old, without cancer from the general UK population. After validation of a random sample (confirmation rate of 96%), we included 4795 hospitalised cases of AMI or CHD deaths. We randomly sampled 20,000 controls, frequency matched by sex, age and calendar year. Relative risks were estimated using unconditional logistic regression.


RESULTS
The adjusted OR for AMI in current users of oral corticosteroids compared to non-users was 1.42 (95% CI: 1.17-1.72). The risk during the first 30 days of use (OR=2.24; 95% CI: 1.56-3.20) was greater than with longer duration (OR=1.22; 95% CI 0.98-1.52). The risk was more pronounced (OR=2.15; 95% CI 1.45-3.14) among users of prednisolone equivalent doses >10mg/day. The dose effect was observed both among patients with and without CHD or COPD/asthma.


CONCLUSIONS
These results suggest a small increased risk of AMI with oral corticosteroid use with a greater risk observed among users of high corticosteroid dose.
Varas-Lorenzo
Cristina
C
Pfizer Worldwide Development, Global Epidemiology, Sant Cugat del Vallès, Barcelona, Spain. cristina.varas@pfizer.com <cristina.varas@pfizer.com>
Rodriguez
Luis Alberto Garcia
LA
Maguire
Andrew
A
Castellsague
Jordi
J
Perez-Gutthann
Susana
S
D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000453:epidemiology; D016017:Odds Ratio; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
D000305:Adrenal Cortex Hormones