Corticosteroids and Cardiac Risk

Corticosteroids represent a potent class of anti-inflammatory and immunosuppressive medications, and they have a multitude of uses in the medical world. Recently, they have played a part in the conversation about therapies for COVID-19, particularly the corticosteroid dexamethasone.

While they are potentially beneficial, it is important to also be aware of the side effect profile of corticosteroids. Among other risks, they can negatively impact the cardiovascular system. Read on to learn more about corticosteroids and cardiac risk.

What Is a Corticosteroid?

Corticosteroids are a synthetic class of medications used to decrease inflammation in the body. Corticosteroids generally accomplish this by suppressing the body’s response to perceived threats; in doing so, they also have the effect of weakening the immune system. Corticosteroids closely resemble a hormone called cortisol that is naturally made by your adrenal glands.

Some commonly prescribed steroids include the following:

• Budesonide (Entocort EC)
• Dexamethasone (Decadron)
• Hydrocortisone (Cortef)
• Methylprednisolone (Medrol)
• Prednisolone (Prelone)
• Prednisone (Deltasone)
• Triamcinolone (Kenalog)

When Are Corticosteroids Prescribed?

Corticosteroids have a wide range of uses in medicine. They may be prescribed for the following conditions, and many others:

• Addison’s disease
• Adrenal insufficiency
• Allergic conditions such as hives
• Asthma
• Blood disorders
• Brain swelling
• Cancer
• Chronic obstructive pulmonary disease (COPD)
• Inflammatory bowel disease
• Multiple sclerosis
• Rheumatoid arthritis
• Systemic lupus erythematosus
• Temporal arteritis

How Do Corticosteroids Impact the Cardiovascular System?

Medical scientists have been analyzing the impact of corticosteroids on the cardiac system for decades. Some studies have shown that users of corticosteroids in excess of 7.5 mg per day are 2.5 times more likely to suffer from an adverse cardiovascular event. Corticosteroids have been implicated in the following cardiovascular conditions:

• High Blood Pressure: Researchers have found that higher doses of corticosteroids are associated with a greater risk of developing high blood pressure in people with chronic inflammatory disease. However, researchers are not sure what causes corticosteroids to increase blood pressure.
• Fluid Retention and Heart Failure: One of the most common side effects of corticosteroids is fluid retention. For patients who have a medical condition that makes them sensitive to fluid overloads, such as heart failure, corticosteroids can worsen their condition.
• Myocardial Infarction (Heart Attack): Corticosteroids may increase the risk of having a myocardial infarction (MI), which is also known as a heart attack. A study in the journal Rheumatology found, after analyzing hospital data of more than 200 patients, that current users of corticosteroids had a 68 percent increased risk of experiencing an MI. Other research has found that MI risk is increased with higher doses of corticosteroids.
• Arrhythmias: Studies have shown that the use of corticosteroids, particularly in high doses, is associated with a greater risk of heart arrhythmia known as atrial fibrillation. In this abnormal heart pattern, the heart beats irregularly, and the blood flow to the brain can be impaired, increasing the risk of stroke. Another abnormal heart rhythm, known as atrial flutter, has also been associated with corticosteroid use, with steroid use doubling the risk of developing this condition.
• High Cholesterol: Corticosteroids are thought to variably affect the lipid cholesterol profile, in some cases raising a person’s LDL or triglyceride levels. Researchers suspect this may have to do with the interplay between lipids and insulin, given that corticosteroids are known to increase insulin resistance. The effect of corticosteroids on lipids may also be due to the propensity of corticosteroids to redistribute body fat, increasing abdominal obesity.
• Sudden Cardiac Death: Case reports of sudden cardiac death have been reported with the use of high-dose intravenous infusions of corticosteroids. However, this is exceedingly uncommon.

Despite these highlighted cardiac risks associated with corticosteroids, some of the data can be confounding because corticosteroids are commonly used to treat inflammatory conditions in which patients already have an underlying elevated risk of cardiac disease. A careful risk-benefit analysis, with attention to your personal medical history, is always the best course of action when deciding whether or not to take a corticosteroid.

What Else Should I Know About Corticosteroids and Cardiac Risk?

As with all side effects of corticosteroids, the shorter the duration of your prescription, the lower the chance of developing an unwanted side effect. An alternate-day dosing schedule or use of the lowest possible dose of the medication may also mitigate your risk; make sure to discuss both of these strategies with your medical provider.

Your cardiac risk while using a corticosteroid may also be altered by using a nonsystemic formulation, meaning a medication other than an oral, IV, or injected form. Nonsystemic options could include an inhaled or topical steroid. Generally, these types of steroids are only therapeutic in certain scenarios, such as when treating dermatologic, ophthalmologic, or pulmonary conditions.

If, after a careful conversation regarding the risks and benefits, your healthcare provider prescribes you a corticosteroid, make sure to use ScriptSave WellRx to get the lowest price at the pharmacy.

Libby Pellegrini is a nationally certified physician assistant. She has worked in numerous healthcare settings, including the rural United States, an inner-city Level I trauma center, several suburban acute care centers, and a boutique, personalized medicine clinic in Southeast Asia. She graduated Magna Cum Laude from Northwestern University’s Medill School of Journalism.

References:

https://www.who.int/news-room/q-a-detail/q-a-dexamethasone-and-covid-19

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