Glucocorticoid use and risk of atrial fibrillation or flutter: a population-based, case-control study.
BACKGROUND
Glucocorticoid use is associated with increased risk of myocardial infarction, stroke, and heart failure, but data are limited on the risk of atrial fibrillation or flutter. We examined whether glucocorticoid use is associated with the risk of atrial fibrillation or flutter.


METHODS
For this population-based, case-control study, we identified all patients with a first hospital diagnosis of atrial fibrillation or flutter from January 1, 1999, through December 31, 2005, in Northern Denmark (population, 1.7 million). For each case we selected 10 population controls matched by age and sex. We obtained data on glucocorticoid prescriptions within 60 days (current users) or longer before the index date (former users), comorbidity, and medications from medical databases. We used conditional logistic regression to compute odds ratios (ORs), controlling for potential confounders.


RESULTS
Among 20,221 patients with atrial fibrillation or flutter, 1288 (6.4%) were current glucocorticoid users and 2375 (11.7%) were former users. Among 202,130 population controls, 5245 (2.6%) were current glucocorticoid users and 19 940 (9.9%) were former users. Current glucocorticoid use was associated with an increased risk of atrial fibrillation or flutter compared with never use (adjusted OR, 1.92; 95% confidence interval [CI], 1.79-2.06). Among new glucocorticoid users, the adjusted OR was 3.62 (95% CI, 3.11-4.22) and among long-term users it was 1.66 (95% CI, 1.53-1.80). The increased risk remained robust in patients with and without pulmonary and cardiovascular diseases. Former glucocorticoid use was not associated with increased risk (adjusted OR, 1.00; 95% CI, 0.96-1.06).


CONCLUSIONS
Current glucocorticoid use was associated with an almost 2-fold increased risk of atrial fibrillation or flutter.
Christiansen
Christian Fynbo
CF
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, DK-8200 Aarhus N, Denmark. cc@dce.au.dk
Christensen
Steffen
S
Mehnert
Frank
F
Cummings
Steven R
SR
Chapurlat
Roland D
RD
Sørensen
Henrik Toft
HT
D001249:Asthma / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000453:epidemiology*; D001282:Atrial Flutter / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors
D005938:Glucocorticoids