Glucocorticoids and Cardiovascular Risk Factors
Section snippets
Glucocorticoids, glucose metabolism, and diabetes
In patients treated with glucocorticoids, the odds ratio for development of new-onset diabetes mellitus has been reported to be 1.36 to 2.31.2 The prevalence of abnormal glucose metabolism in postrenal transplant patients taking glucocorticoids has been reported to be 17% to 32%.3, 4 Smaller studies in patients treated with glucocorticoids for various neurologic diseases5 and rheumatoid arthritis6 have reported even greater prevalence. The risk of impaired glucose tolerance is probably not a
Glucocorticoids and lipids
Glucocorticoid administration is a known, reversible cause of dyslipidemia. The prevalence of dyslipidemia among transplant recipients taking glucocorticoids is more than 80% for heart, 60% to 70% for renal, and 45% for liver.30 These results may be confounded by concurrent use of other immunosuppressant agents. However, patients treated with glucocorticoid monotherapy for inflammatory diseases such as sarcoidosis, uveitis,31 systemic lupus erythematosus,32 and asthma33 also show increased
Glucocorticoids and other risk factors
The diverse actions of glucocorticoids on other systems may also contribute to increased cardiovascular risk. Elsewhere in this issue, Ong and Whitworth summarize recent advances in understanding of how glucocorticoid treatment causes hypertension. The renin–angiotensin system may contribute to increased cardiovascular disease even when hypertension is not present.59 Unlike mineralocorticoid excess, which suppresses the renin system, glucocorticoid therapy tends to increase plasma renin
Summary
Glucocorticoids remain a valuable and necessary component of therapy for many diseases. Nonetheless, sustained glucocorticoid treatment increases potential for future cardiovascular disease through multiple pathways, resulting in a tradeoff between benefit and harm. This article, and one by Ong and Whitworth elsewhere in this issue, summarize these pathways. Safe, alternate strategies for minimizing the need for glucocorticoids are urgently needed.
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2022, Journal of Infection and ChemotherapyGlucocorticoid receptor (NR3C1) gene polymorphisms are associated with age and blood parameters in Polish Caucasian nonagenarians and centenarians
2019, Experimental GerontologyCitation Excerpt :The association of select polymorphisms of the NR3C1 gene with age reinforces the role of pathways initiated by glucocorticoid receptor in longevity regulation. One of the putative mechanisms of this phenomenon is that, in accordance with the physiological function of glucocorticoids (Reynolds, 2010; Strohmayer and Krakoff, 2011; Quax et al., 2013; Lee et al., 2014), NR3C1 sequence variants might modify hormone effects on serum levels of glucose and lipids or the intensity of ageing-associated chronic low-grade inflammation that leads to the development of ageing-related diseases (De Guia and Herzig, 2015; Kuo et al., 2015; Monti et al., 2016). Till now, functional consequences of the studied NR3C1 polymorphisms are not known, however, in a genome-wide association study, the rs291841 SNP was found to be associated with physical performance in long-lived individuals (Lunetta et al., 2007).
Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis
2018, Best Practice and Research: Clinical RheumatologyCitation Excerpt :There are no studies specifically addressing NSAID use on CV risk in a PsA population. Excess exogenous corticosteroids increase CV risk through pleiotropic effects that are often dependent on cumulative dosage and duration [101]. In a meta-analysis by Roubille et al., corticosteroids increased the risk of all MACE in RA, although this may be related to confounding by indication [102].
Randomized clinical trial of the efficacy and safety of insulin glargine vs. NPH insulin as basal insulin for the treatment of glucocorticoid induced hyperglycemia using continuous glucose monitoring in hospitalized patients with type 2 diabetes and respiratory disease
2015, Diabetes Research and Clinical PracticeCitation Excerpt :It is well known that efforts to minimize hyperglycemia and hyperglycemic excursions are of benefit to participants exposed to glucocorticoids. Short-term or postprandial hyperglycemias are associated with acute inflammation and endothelial dysfunction [17] and an increased cardiovascular risk [18], in people without diabetes and in those with T2DM. As strength of our study, we highlight its design as a randomized clinical trial.
Long-Term Toxicity of Immunosuppressive Therapy
2015, Transplantation of the Liver: Third EditionHidradenitis suppurativa and risk of coronary artery disease: A systematic review and meta-analysis
2023, Indian Journal of Dermatology
Financial Disclosures: The authors have nothing to disclose.