RESEARCH - Steroids and cardiovascular events in RA

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Arthritis Rheum. 2007 Feb 28;56(3):820-830 [Epub ahead of print]

Glucocorticoids and cardiovascular events in rheumatoid arthritis: A

population-based cohort study.

JM 3rd, Maradit Kremers H, Crowson CS, Nicola PJ, Ballman KV, Therneau

TM, VL, SE.

Mayo Clinic, Rochester, Minnesota.

OBJECTIVE: To determine the relationship between glucocorticoid exposure and

cardiovascular (CV) events in patients with rheumatoid arthritis (RA).

METHODS: A total of 603 adult residents of Rochester, Minnesota with

incident RA between 1955 and 1995 were followed up through their medical

records for a median of 13 years (total of 9,066 person-years).

Glucocorticoid exposure was defined 3 ways: tertiles of cumulative exposure;

recent use (</=3 months) versus past use (>3 months); and average daily

dosage (</=7.5 mg/day or >7.5 mg/day). CV events, including myocardial

infarction, heart failure, and death from CV causes, were defined according

to validated criteria. regression models were adjusted for demographic

features, CV risk factors, and RA characteristics. RESULTS: Rheumatoid

factor (RF)-negative patients with exposure to glucocorticoids were not at

increased risk of CV events, irrespective of the glucocorticoid dosage or

timing of use, as compared with the reference group of RF-negative patients

who had never been exposed to glucocorticoids. In contrast, RF-positive

patients were at increased risk of CV events, particularly with higher

cumulative exposure, higher average daily dosage, and recent use of

glucocorticoids. RF-positive patients with high cumulative exposure to

glucocorticoids had a 3-fold increased risk of CV events (hazard ratio 3.06

[95% confidence interval 1.81-5.18]), whereas RF-negative patients with high

cumulative exposure were not at increased risk (hazard ratio 0.85 [95%

confidence interval 0.39-1.87]).

CONCLUSION: RF-positive but not RF-negative patients were at increased risk

of CV events following exposure to glucocorticoids. These findings suggest

that glucocorticoids interact with RF status to modulate the occurrence of

CV events in patients with RA. The mechanisms underlying this interaction

are unknown and should be the subject of further research.

PMID: 17330254

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

7330254 & dopt=Abstract

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