Glucocorticoids and Cardiovascular Risk Factors

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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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    Financial Disclosures: The authors have nothing to disclose.

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