Glucocorticoids and the cardiovascular system: state of the art.
Glucocorticoids (GC) are drugs commonly used, by approximately 1% of the total adult population as anti-inflammatory and immunosuppressive therapies for asthma, inflammatory bowel disease, dermatological, ophthalmic, neurological, and rheumatic autoimmune diseases. Supporting evidence exists of GC use in both immune mediated and non-immune mediated heart disease. The molecular mechanisms by which GC induces immune-modulation and direct cardioprotection, are complex and not fully understood. We review herein, the current knowledge of GC use in various immune-mediated or non-immune mediated cardiovascular conditions. GC have been investigated in autoimmune, inflammatory and idiopathic heart diseases such as atrio-ventricular conduction abnormalities, rheumatic fever, myocarditis, dilated cardiomyopathy, Churg-Strauss syndrome, Kawasaki disease and sarcoidosis. GC therapy has been studied in non-autoimmune and non-inflammatory indications such as acute myocardial infarction, angina, postpericardiotomy syndrome and other pericardial diseases, endocarditis and cardiac amyloidosis, as well as in invasive cardiology, coronary interventions, and cardiopulmonary-bypass surgery. Despite GC's role as natural, physiologic regulators of the immune system, cardiovascular adverse outcomes may occur. Some of the well-known side effects of GC therapy involve bone, metabolic, and cardiovascular systems and include osteoporosis, fractures, dyslipidemia, diabetes, obesity, and hypertension.
Department of Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Israel.
Udi
U
Nussinovitch
Jozélio Freire
JF
de Carvalho
Rosa Maria R
RM
Pereira
Yehuda
Y
Shoenfeld
D002318:Cardiovascular Diseases / Q000188:drug therapy; D002319:Cardiovascular System / Q000187:drug effects*; D005938:Glucocorticoids / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans
D005938:Glucocorticoids