title: Glucocorticoids and cardiovascular and cerebrovascular events in polymyalgia rheumatica.
abstract: OBJECTIVE
  To examine the effect of glucocorticoid use on the risk of various cardiovascular diseases in patients with polymyalgia rheumatica (PMR).
  
  
  METHODS
  We assembled a population-based incidence cohort of 364 patients with PMR first diagnosed between January 1, 1970 and December 31, 1999. Inclusion criteria were age > or = 50 years, bilateral aching and morning stiffness involving at least 2 areas (neck, shoulders, hips, or proximal aspects of the thighs), and erythrocyte sedimentation rate (ESR) > or = 40 mm/hour. In patients who fulfilled the first 2 criteria but had a normal ESR, a rapid response to low-dose glucocorticoids served as the third criterion. Patients were followed up until death or December 31, 2004. Cox models with time-dependent covariates were used to examine the association between glucocorticoid exposure and risk of myocardial infarction, heart failure, peripheral vascular disease, and cerebrovascular disease.
  
  
  RESULTS
  A total of 364 PMR patients (mean age 73 years, 67% women) were followed for a median of 7.6 years. During the disease course, 310 (85%) patients received glucocorticoids. After adjusting for age, calendar year, and ESR, patients who received glucocorticoids did not have a significantly higher risk for myocardial infarction, heart failure, peripheral vascular disease, or cerebrovascular disease (hazard ratio [95% confidence interval] 0.58 [0.29-1.18], 0.85 [0.45-1.54], 0.58 [0.24-1.40], and 0.65 [0.33-1.26], respectively) compared with those who did not receive glucocorticoids. In fact, a trend for a protective effect was seen. No significant association was observed between cumulative glucocorticoid dose and any of the outcomes (P = 0.39).
  
  
  CONCLUSIONS
  In patients with PMR, treatment with glucocorticoids is not associated with an increased risk of cardiovascular diseases.
authors.affiliation: Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Hilal
authors.initials: H
authors.lastname: Maradit Kremers
authors.forename: Megan S
authors.initials: MS
authors.lastname: Reinalda
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Crowson
authors.forename: John M
authors.initials: JM
authors.lastname: Davis
authors.forename: Gene G
authors.initials: GG
authors.lastname: Hunder
authors.forename: Sherine E
authors.initials: SE
authors.lastname: Gabriel
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D011111:Polymyalgia Rheumatica / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D005938:Glucocorticoids