Screen for cardiovascular risk factors in Cushing's patients who use glucocorticoids

People who use glucocorticoids and exhibit iatrogenic Cushing's syndrome should be aggressively targeted for early screening and management of cardiovascular risk factors, a study found.

Researchers conducted a cohort study comparing British patients prescribed systemic glucocorticoids who had a diagnosis of iatrogenic Cushing's syndrome (n=547) with two other groups: those prescribed glucocorticoids with no diagnosis of iatrogenic Cushing's syndrome (n=3,231) and those not prescribed systemic glucocorticoids (n=3,282). Results appeared online July 30 at BMJ.

A total of 417 cardiovascular events occurred in 341 patients among the 424 U.K. general practices in the study. The adjusted overall hazard ratio of a cardiovascular event was 2.74 (95% CI, 2.06 to 3.62) for those prescribed glucocorticoids with Cushing's syndrome compared with the group prescribed glucocorticoids without Cushing's syndrome. Patients prescribed glucocorticoids with iatrogenic Cushing's syndrome also had a higher adjusted hazard ratio of any cardiovascular event (4.16; 95% CI, 2.98 to 5.82) compared with those not prescribed glucocorticoids.

Results were similar when people with a history of cardiovascular events (n=1,004) were excluded from the analyses. Adjusted hazard ratios of all cardiovascular events were 2.56 (95% CI, 1.66 to 3.94) for the steroid/Cushing's group compared to steroid/no Cushing's patients and 4.26 (95% CI, 2.49 to 7.29) compared with the group not prescribed glucocorticoids.

The authors concluded that a glucocorticoid-induced cushingoid appearance should no longer be considered as a minor adverse event. “It has been reported by patients as the most distressing adverse event affecting daily living and is associated with some features of the metabolic syndrome. Furthermore, we found that it is associated with a higher risk of cardiovascular events, particularly heart failure and coronary heart disease. It is therefore essential that patients prescribed glucocorticoids who develop iatrogenic Cushing's syndrome are assessed for cardiovascular risk and monitored regularly in both primary care and secondary care for early prevention of cardiovascular diseases,” they wrote.