[Increased cardiovascular risk due to glucocorticoids: how strong is the evidence?] / Verhoogd cardiovasculair risico door glucocorticoïden.

ABSTRACT

Glucocorticoids are important for treatment of (auto-)immune diseases. Prolonged use of high dose glucocorticoids increases the cardiovascular disease risk. Underlying mechanisms have not been fully elucidated but increased incidence of traditional cardiovascular risk factors and enhanced (V)LDL-cholesterol synthesis are important contributors. If and to what extent this also holds for low-dose corticosteroids (< 7.5mg prednisolone/day) is still unknown. The current evidence is based on observational studies which are often dominated by 'confounding by indication', as disease activity itself is an independent cardiovascular risk factor, and particularly patients with active disease are more likely to receive higher doses of glucocorticoids. Future studies (preferably RCT's) with disease activity data and medication use are required to solve this issue. Obviously, we must always remain critical regarding the use of glucocorticoids and aim for the lowest possible adequate dose and shortest treatment duration.