A new study published in the New England Journal of Medicine shows the incidence of cardiovascular disease correlates strongly with the four metabolic domains used in the Steritas GTI-MD (body mass index, systolic blood pressure, non-high-density lipoprotein cholesterol, and diabetes) alongside smoking status. [1]
Steroid-toxicity and the risk of cardiovascular disease
Evidence is mounting that even low doses of steroids can significantly increase an individual’s risk of cardiovascular disease and death with long-term use.
In a population-based cohort analysis of 87,794 patient records spanning two decades (1998-2017), a strong dose-dependent risk of cardiovascular disease was found in patients receiving the glucocorticoid prednisolone at relatively low doses. [2]
Contrary to the widely held belief that doses of less than 5 mg of prednisolone are safe long term, the analysis showed that after a year of treatment, the risk of cardiovascular disease doubled for individuals taking less than 5 mg prednisolone a day, and was 6 times higher for those using 25 mg or greater.
Based on their findings, the authors recommended that physicians prescribe the lowest effective steroid dose and implement personalized cardiovascular disease risk prevention plans that take into account the patient’s current and prior steroid use. Moreover, they called for refinement of existing risk prediction tools to aid prevention of cardiovascular diseases in individuals receiving steroids.
New research shows 5 risk factors account for over 50% of cardiovascular cases
Many of the individuals in the studies referenced above had known modifiable cardiovascular risk factors, such as obesity and hypertension. It follows that identifying and routinely monitoring the most influential of these factors in at-risk populations could go a long way to helping clinicians predict and prevent the incidence of cardiovascular disease and related fatalities. This is reinforced by a recent study published by the Global Cardiovascular Risk Consortium showing that strict control of just 5 modifiable factors could potentially halve the risk of cardiovascular disease.[1]
While the prevalence and effect of these factors on the incidence of cardiovascular disease varied with sex and geographic region, the implication is that risk-prediction tools based on a combination of these could significantly aid prediction and prevention of cardiovascular disease.
Steroid-toxicity and cardiovascular disease have shared risk factors
Notably, data relating to 4 out of 5 of the above risk factors form the core of the GTI-MD, the new clinical outcome assessment recently launched by Steritas to enable routine monitoring of steroid-toxicity in clinical practice. The GTI-MD streamlines data analysis to four metabolic GTI domains: body mass index, glucose tolerance, blood pressure, and lipid metabolism. The data comprising these domains are routinely and easily captured during a typical clinic visit, and their combined use in the GTI-MD instrument has been validated for the ability to reliably identify clinically relevant steroid-toxicity.
Why is this important?
The significant overlap of the GTI-MD domains with risk factors highlighted by the Global
Cardiovascular Risk Consortium study is a reassuring indication that the data being analyzed by the GTI-MD instrument are relevant to effectively monitor and lower the incidence of cardiovascular disease among steroid users. The findings are also consistent with there being common biological mechanisms at play in the development of cardiovascular disease and steroid-toxicity, which hints at the potential for wider application of the GTI-MD beyond steroid-toxicity assessment. While many questions remain, particularly regarding the relative contribution of smoking, we look forward to further progress in this area.
References
- The Global Cardiovascular Risk Consortium. Global effect of modifiable risk factors on cardiovascular disease and mortality. N Engl J Med (2023) 389:1273-1285.
- Pujades-Rodriguez M, Morgan AW, Cubbon RM, Wu J. Dose-dependent oral glucocorticoid cardiovascular risks in people with immune-mediated inflammatory diseases: A population-based cohort study. PLoS Med (2020) 17(12): e1003432.