Glucocorticoids and cardiovascular and cerebrovascular events in polymyalgia rheumatica

Hilal D Maradit Kremers, Megan S. Reinalda, Cynthia Crowson, John Manley III Davis, Gene G. Hunder, Sherine E. Gabriel

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

Objective. To examine the effect of glucocorticoid use on the risk of various cardiovascular diseases in patients with polymyalgia rheumatica (PMR). Methods. We assembled a population-based incidence cohort of 364 patients with PMR first diagnosed between January 1, 1970 and December 31, 1999. Inclusion criteria were age ≥50 years, bilateral aching and morning stiffness involving at least 2 areas (neck, shoulders, hips, or proximal aspects of the thighs), and erythrocyte sedimentation rate (ESR) S40 mm/hour. In patients who fulfilled the first 2 criteria but had a normal ESR, a rapid response to low-dose glucocorticoids served as the third criterion. Patients were followed up until death or December 31, 2004. Cox models with time-dependent covariates were used to examine the association between glucocorticoid exposure and risk of myocardial infarction, heart failure, peripheral vascular disease, and cerebrovascular disease. Results. A total of 364 PMR patients (mean age 73 years, 67% women) were followed for a median of 7.6 years. During the disease course, 310 (85%) patients received glucocorticoids. After adjusting for age, calendar year, and ESR, patients who received glucocorticoids did not have a significantly higher risk for myocardial infarction, heart failure, peripheral vascular disease, or cerebrovascular disease (hazard ratio [95% confidence interval] 0.58 [0.29-1.18], 0.85 [0.45-1.54], 0.58 [0.24-1.40], and 0.65 [0.33-1.26], respectively) compared with those who did not receive glucocorticoids. In fact, a trend for a protective effect was seen. No significant association was observed between cumulative glucocorticoid dose and any of the outcomes (P = 0.39). Conclusion. In patients with PMR, treatment with glucocorticoids is not associated with an increased risk of cardiovascular diseases.

Original languageEnglish (US)
Pages (from-to)279-286
Number of pages8
JournalArthritis Care and Research
Volume57
Issue number2
DOIs
StatePublished - Mar 15 2007

Fingerprint

Polymyalgia Rheumatica
Glucocorticoids
Blood Sedimentation
Cerebrovascular Disorders
Peripheral Vascular Diseases
Cardiovascular Diseases
Heart Failure
Myocardial Infarction
Thigh
Proportional Hazards Models
Hip
Neck
Confidence Intervals
Incidence

Keywords

  • Cardiovascular disease
  • Glucocorticoid therapy
  • Polymyalgia rheumatica

ASJC Scopus subject areas

  • Rheumatology

Cite this

Glucocorticoids and cardiovascular and cerebrovascular events in polymyalgia rheumatica. / Maradit Kremers, Hilal D; Reinalda, Megan S.; Crowson, Cynthia; Davis, John Manley III; Hunder, Gene G.; Gabriel, Sherine E.

In: Arthritis Care and Research, Vol. 57, No. 2, 15.03.2007, p. 279-286.

Research output: Contribution to journalArticle

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abstract = "Objective. To examine the effect of glucocorticoid use on the risk of various cardiovascular diseases in patients with polymyalgia rheumatica (PMR). Methods. We assembled a population-based incidence cohort of 364 patients with PMR first diagnosed between January 1, 1970 and December 31, 1999. Inclusion criteria were age ≥50 years, bilateral aching and morning stiffness involving at least 2 areas (neck, shoulders, hips, or proximal aspects of the thighs), and erythrocyte sedimentation rate (ESR) S40 mm/hour. In patients who fulfilled the first 2 criteria but had a normal ESR, a rapid response to low-dose glucocorticoids served as the third criterion. Patients were followed up until death or December 31, 2004. Cox models with time-dependent covariates were used to examine the association between glucocorticoid exposure and risk of myocardial infarction, heart failure, peripheral vascular disease, and cerebrovascular disease. Results. A total of 364 PMR patients (mean age 73 years, 67{\%} women) were followed for a median of 7.6 years. During the disease course, 310 (85{\%}) patients received glucocorticoids. After adjusting for age, calendar year, and ESR, patients who received glucocorticoids did not have a significantly higher risk for myocardial infarction, heart failure, peripheral vascular disease, or cerebrovascular disease (hazard ratio [95{\%} confidence interval] 0.58 [0.29-1.18], 0.85 [0.45-1.54], 0.58 [0.24-1.40], and 0.65 [0.33-1.26], respectively) compared with those who did not receive glucocorticoids. In fact, a trend for a protective effect was seen. No significant association was observed between cumulative glucocorticoid dose and any of the outcomes (P = 0.39). Conclusion. In patients with PMR, treatment with glucocorticoids is not associated with an increased risk of cardiovascular diseases.",
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