Cardiovascular risk induced by low-dose corticosteroids in rheumatoid arthritis: a systematic literature review.
OBJECTIVE
To assess the association between cardiovascular (CV) risk and low-dose corticosteroids (LD-CT, defined as a daily dose <10mg/day of prednisone) in rheumatoid arthritis (RA) patients.


METHODS



METHODS
A systematic review of the literature up to June 2009 was performed.


METHODS
(1) cardiovascular risk factors: high blood pressure, glycemia and lipid profile, carotid intima-media thickness, pulse-wave velocity, ventricular function; (2) "hard" outcomes: heart failure (HF), stroke, myocardial infarction (MI) or mortality.


METHODS
descriptive, comparing CV risk between LD-CT-treated RA patients and LD-CT-non-treated RA patients.


RESULTS
Of the 1138 screened reports, the literature search identified 37 assessing CV risk in LD-CT treated RA. The analysis showed a protective effect on serum lipid profile, an increase of insulin resistance or glycemia, probably no effect on blood pressure, no effect on atherosclerosis, discrepancies regarding arterial stiffness and no effect on ventricular function or heart rate variability. An association of LD-CT with major CV events was found in 4/6 studies. This included MI (HR=1.7 [1.2-2.3]), stroke (OR=4.36 [1.60-11.90] for LDC between 6 and 10mg/day), mortality (HR=2.03 [1.25-3.32]) and a composite index of CV events (in the group of rheumatoid factor positive RA, HR=2.21 [1.22-4.00]). Two studies did not find any significant association between LD-CT exposure and mortality (OR=2.25 [0.29-102.5]) or a composite index of CV events (OR=1.3 [0.8-2.0]).


CONCLUSIONS
Although the literature review showed poor association between LDC exposure and CV risk factors, a trend of increasing major CV events was identified.
Ruyssen-Witrand
Adeline
A
Service de rhumatologie B, hôpital Cochin, AP-HP, université Paris-V René-Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France. adruyssen@hotmail.com
Fautrel
Bruno
B
Saraux
Alain
A
Le Loët
Xavier
X
Pham
Thao
T
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D012307:Risk Factors
D000305:Adrenal Cortex Hormones