title: Oral corticosteroids and onset of cardiomyopathy in Duchenne muscular dystrophy.
abstract: OBJECTIVE
  To estimate the age when cardiomyopathy develops in boys with Duchenne muscular dystrophy (DMD) and to analyze the effect of corticosteroid treatment on the age of cardiomyopathy onset.
  
  
  METHODS
  We identified a population-based sample of 462 boys with DMD, born between 1982 and 2005, in 5 surveillance sites in the US. Echocardiographic and corticosteroid treatment data were collected. Cardiomyopathy was defined by a reduced fractional shortening (<28%) or ejection fraction (<55%). The age of cardiomyopathy onset was determined. Survival analysis was performed to determine the effects of corticosteroid treatment on cardiomyopathy onset.
  
  
  RESULTS
  The mean (SD) age of cardiomyopathy onset was 14.3 (4.2) years for the entire population and 15.2 (3.4) years in corticosteroid-treated vs 13.1 (4.8) in non-treated boys. Survival analysis described a significant delay of cardiomyopathy onset for boys treated with corticosteroids (P < .02). By 14.3 years of age, 63% of non-treated boys had developed cardiomyopathy vs only 36% of those treated. Among boys treated with corticosteroids, there is a significant positive effect of duration of corticosteroid treatment on cardiomyopathy onset (P < .0001). For every year of corticosteroid treatment, the probability of developing cardiomyopathy decreased by 4%.
  
  
  CONCLUSIONS
  Oral corticosteroid treatment was associated with delayed cardiomyopathy onset. The duration of corticosteroid treatment also correlated positively with delayed cardiomyopathy onset. Our analysis suggests that a boy with DMD treated for 5 years with corticosteroids might experience a 20% decrease in the likelihood of developing cardiomyopathy compared with untreated boys.
authors.affiliation: Department of Pediatrics, University of Arizona College of Medicine, Tucson, AZ. Electronic address: barberb@peds.arizona.edu.
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Barber
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Andrews
authors.forename: Zhenqiang
authors.initials: Z
authors.lastname: Lu
authors.forename: Nancy A
authors.initials: NA
authors.lastname: West
authors.forename: F John
authors.initials: FJ
authors.lastname: Meaney
authors.forename: Elinora T
authors.initials: ET
authors.lastname: Price
authors.forename: Ashley
authors.initials: A
authors.lastname: Gray
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Sheehan
authors.forename: Shree
authors.initials: S
authors.lastname: Pandya
authors.forename: Michele
authors.initials: M
authors.lastname: Yang
authors.forename: Christopher
authors.initials: C
authors.lastname: Cunniff
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D017668:Age of Onset; D009202:Cardiomyopathies / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D006801:Humans; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000150:complications* / Q000188:drug therapy*; D012044:Regression Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones
keywords: ACE; Angiotensin-converting enzyme; DMD; Duchenne muscular dystrophy; EF; Ejection fraction; FS; Fractional shortening; LV; Left ventricle; MD STARnet; Muscular Dystrophy Surveillance, Tracking, and Research Network