title: Impact of long-term steroid therapy on epicardial and pericardial fat deposition: a cardiac MRI study.
abstract: BACKGROUND
  Increased cardiac fat has been identified as a risk factor for coronary artery disease. Metabolic syndrome is associated with increased cardiac fat deposition. Steroids are known to imitate some effects of metabolic syndrome and are frequently used in patients with rheumatic disorders. Primary aim was to evaluate the impact of long-term steroid use on cardiac fat deposition in patients with rheumatic disorders. In addition, we sought to investigate if this effect might be dose-dependent.
  
  
  METHODS
  Patients were enrolled as follows: (1) rheumatic disorder; and (2) long-term steroid therapy, and (3) underwent cardiovascular magnetic resonance (CMR) imaging. Patients were stratified in a high-dose (>7.5 mg prednisone equivalent/day for at least 6 months) and a low-dose steroid group (<7.5 mg prednisone equivalent/day) and compared to steroid-naïve controls without rheumatic disorders.
  
  
  RESULTS
  122 patients were included (n = 61 steroid patients, n = 61 controls). N = 36 were classified as high-dose, n = 25 as low-dose steroid group. Steroid patients showed larger epicardial 5.7 [3.5-9.1] cm(2) and pericardial 13.0 [6.1-26.8] cm(2) areas of fat than controls 4.2 [1.3-5.8] cm(2)/6.4 [1.6-15.4] cm(2), p < 0.001, p < 0.01, respectively. High-dose steroid patients had more epi- and pericardial fat both than controls: 7.2 [4.2-11.1] cm(2) vs. 4.4 [1.0-6.0] cm(2), p < 0.001; 18.6 [8.9-38.2] cm(2) vs. 10.7 [4.7-26.8] cm(2), p < 0.05, and patients in the low-dose steroid group (p < 0.01, p < 0.001, respectively).
  
  
  CONCLUSIONS
  The present data suggest increased cardiac fat deposition in steroid-treated patients with rheumatic disorders. Furthermore, this accumulation of cardiac fat seems to be dose-dependent, pointing towards a cumulative effect of steroids.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany. Daniel.Kitterer@rbk.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kitterer
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany. Joerg.Latus@rbk.de.
authors.forename: Joerg
authors.initials: J
authors.lastname: Latus
authors.affiliation: Division of Rheumatology, Department of Internal Medicine II, Universitätsklinik Tübingen, Tübingen, Germany. joerg.henes@med.uni-tuebingen.de.
authors.forename: Joerg
authors.initials: J
authors.lastname: Henes
authors.affiliation: Department of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany. Stefan.Birkmeier@rbk.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Birkmeier
authors.affiliation: Department of Radiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany. Maik.Backes@rbk.de.
authors.forename: Maik
authors.initials: M
authors.lastname: Backes
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany. niko-braun@t-online.de.
authors.forename: Niko
authors.initials: N
authors.lastname: Braun
authors.affiliation: Department of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany. Udo.Sechtem@rbk.de.
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany. Dominik.Alscher@rbk.de.
authors.forename: M
authors.initials: M
authors.lastname: Dominik Alscher
authors.affiliation: Department of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany. Heiko.Mahrholdt@rbk.de.
authors.forename: Heiko
authors.initials: H
authors.lastname: Mahrholdt
authors.affiliation: Department of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany. Simon.Greulich@rbk.de.
authors.forename: Simon
authors.initials: S
authors.lastname: Greulich
mesh_terms: D000273:Adipose Tissue / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D050154:Adiposity / Q000187:drug effects*; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D010496:Pericardium; D011237:Predictive Value of Tests; D011241:Prednisone / Q000009:adverse effects*; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D005938:Glucocorticoids; D011241:Prednisone