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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 2, March/April 2021
112
AFRICA
Although research is still needed to delineate the time of day
when melatonin therapy should be given, pre-clinical findings,
strengthened by the findings that melatonin levels are lower in
patients suffering from PAH, strongly suggest that melatonin,
given via a diet rich in melatonin, is worth testing as a safe,
simple and inexpensive therapy that could benefit PAH patients,
especially in resource-limited settings where patients cannot
receive expensive, targeted PAH therapies.
Professor S Lecour receives funding from Winetech for part of her research.
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Even low-dose steroid treatments substantially increase cardiovascular disease risk
While high doses of steroids are known to increase the risk
of cardiovascular disease (CVD), the impact of lower doses
is unknown. A Leeds University study in
PLOS Medicine
suggests that even low doses of glucocorticoid may increase
the risk of CVD.
Why was this study done?
•
Glucocorticoids (steroids) are widely used to reduce
disease activity and inflammation in patients with a range
of immune-mediated inflammatory diseases, such as
rheumatoid arthritis, polymyalgia rheumatica, giant cell
arteritis and inflammatory bowel disease.
•
Adequate assessment of cost-effectiveness of new steroid-
sparing treatments for immune and inflammatory diseases
requires modelling of estimates of risk and cost of the
main treatment complications of steroids.
•
It is widely recognised that high-dose steroids may increase
the risk of CVD (heart disease, stroke, or other vascular
diseases), but it is debated whether this increase also
applies to lower steroid doses.
•
Earlier studies of CVD risk associated with glucocorticoid
therapy failed to account for changes in dose over time
and for use of non-oral steroids and other potentially
confounding therapies.
What did the researchers do and find?
•
In 87 794 adults with immune-mediated inflammatory
diseases and no prior CVD (five-year median follow up),
we studied the risk of six common CVDs associated with
the steroid dose prescribed, quantified either as current or
as cumulative dose.
•
We found strong dose-dependent risks of all CVDs,
including myocardial infarction, heart failure, atrial fibril-
lation and cerebrovascular disease, in patients diagnosed
with the six inflammatory diseases studied.
•
After one year, the overall absolute risk of CVD doubled
for individuals using less than 5 mg prednisolone per day
and was six times higher for users of 25 mg or greater.
•
Many individuals had known modifiable cardiovascular
risk factors, including current smoking (24%), obesity
(25%) or hypertension (25%).
What do these findings mean?
•
We have provided evidence that individuals receiving
steroids have an increased risk of developing a broad
spectrum of fatal and non-fatal CVDs and that this risk
increases with the dose of steroids and with the duration
of steroid treatment.
•
It was previously believed that less than 5 mg of predniso-
lone was safe long term, but even at this ‘low dose’ patients
with immune-mediated inflammatory diseases have a
doubling of their underlying risk of CVD.
•
New treatment approaches that avoid the need for long-
term steroid treatment and have better cardiovascular
safety profile are required for immune-mediated inflam-
matory diseases.
•
All patients requiring long-term steroid treatment should
be prescribed the lowest effective steroid dose and have
a personalised CVD risk-prevention plan that takes into
account current and prior steroid use.
Source:
Medical Brief 2020