title: Cardiovascular risk induced by low-dose corticosteroids in rheumatoid arthritis: a systematic literature review.
abstract: 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.
authors.affiliation: 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
authors.forename: Adeline
authors.initials: A
authors.lastname: Ruyssen-Witrand
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.forename: Xavier
authors.initials: X
authors.lastname: Le Loët
authors.forename: Thao
authors.initials: T
authors.lastname: Pham
mesh_terms: 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
chemical_list: D000305:Adrenal Cortex Hormones