KORTISONI/RYTMIHÄIRIÖT

[Bb]

Lähettäjä: Soijuv Lähetetty: 16.5.2006 8:13

Uuden tutkimuksen mukaan suuret kortisoniannokset joita käytetään esim niveltulehduksissa ja astmassa saattavat lisätä sydämen rytmihäiriöitä (eteisvärinää). Tutkimuksessa seurattiin 10 vuoden ajan 7983 aikuista kortisonin käyttäjää. Kortisonia käyttävillä oli 6 kertaa suurempi todennäköisyys saada rytmihäiriöitä.


Corticosteroids linked to heart rhythm condition
09 May 2006
Arch Intern Med 2006; 166: 1016-1020

High doses of corticosteroids ? medications used to treat asthma and other
conditions such as arthritis ? may increase the risk of a heart rhythm
disorder called atrial fibrillation, say Dutch researchers.

Atrial fibrillation occurs when the muscles of the heart's two upper
chambers contract irregularly. People with this disorder have an increased
risk of strokes and other cardiovascular complications, write Dr Cornelis
van der Hooft, from Erasmus University Medical Center in Rotterdam, and
colleagues in the Archives of Internal Medicine.

Following unconfirmed reports that high doses of corticosteroids may be
associated with atrial fibrillation, the researchers studied corticosteroid
use and the incidence of atrial fibrillation among 7983 adults who were aged
55 years or older in 1990.

Over the 10-year monitoring period, 385 cases of atrial fibrillation
occurred among the participants.

Analysis revealed that those who had received a prescription for high-dose
corticosteroids within 1 month of starting the study were six times more
likely to experience atrial fibrillation than those who had never taken the
medication.

Furthermore, the patients' underlying conditions did not affect their risk
for atrial fibrillation; those who were prescribed high-dose corticosteroids
for asthma or chronic obstructive pulmonary disease had the same increased
risk of developing atrial fibrillation as those patients who took the
medication to treat arthritis, allergies or blood cancers.

The researchers conclude: "Our findings suggest that patients receiving
high-dose corticosteroid therapy are at increased risk of developing atrial
fibrillation."

They add: "Because persons who develop atrial fibrillation are at increased
risk of serious cardiovascular complications such as heart failure and
ischemic stroke...early detection of atrial fibrillation is essential."

Vol. 166 No. 9, May 8, 2006

Corticosteroids and the Risk of Atrial Fibrillation
Cornelis S. van der Hooft, MD; Jan Heeringa, MD; Guy G. Brusselle, MD, PhD;
Albert Hofman, MD, PhD; Jacqueline C. M. Witteman, PhD; J. Herre Kingma, MD,
PhD; Miriam C. J. M. Sturkenboom, PharmD, PhD; Bruno H. Ch. Stricker, MB,
PhD

Arch Intern Med. 2006;166:1016-1020.

Background High-dose (pulse) corticosteroid therapy has been associated
with the development of atrial fibrillation. This association, however, is
mainly based on case reports.

Methods To test the hypothesis that high-dose corticosteroid exposure
increases the risk of new-onset atrial fibrillation, we performed a nested
case-control study within the Rotterdam Study, a population-based cohort
study among 7983 older adults. Cases were defined as persons with incident
atrial fibrillation between July 1, 1991, and January 1, 2000. Their date of
diagnosis was defined as the index date. All noncases within the Rotterdam
Study who were alive and eligible on this index date were used as controls.
Subsequently, we compared the proportion of cases and controls that received
a corticosteroid prescription within 1 month preceding the index date.
Corticosteroid exposure was categorized into high-dose exposure (oral or
parenteral steroid at a daily dose 7.5 mg of prednisone equivalents) and
low-intermediate­dose exposure (<7.5 mg of prednisone equivalents or inhaled
corticosteroids).

Results There were 385 eligible cases of new-onset atrial fibrillation
during the study period. The risk of new-onset atrial fibrillation was
significantly higher for persons who received a corticosteroid prescription
within 1 month before the index date than for those without (odds ratio
[OR], 3.75; 95% confidence interval [CI], 2.38-5.87). However, only
high-dose corticosteroid use was associated with an increased risk (OR,
6.07; 95% CI, 3.90-9.42), whereas low-intermediate­dose use was not (OR,
1.42; 95% CI, 0.72-2.82). The association of atrial fibrillation with
high-dose corticosteroid use was largely independent of the indication for
corticosteroid therapy, since the risk of new-onset atrial fibrillation was
not only increased in patients with asthma or chronic obstructive pulmonary
disease (OR, 4.02; 95% CI, 2.07-7.81) but also in patients with rheumatic,
allergic, or malignant hematologic diseases (OR, 7.90; 95% CI, 4.47-13.98 ).

Conclusion Our findings strongly suggest that patients receiving high-dose
corticosteroid therapy are at increased risk of developing atrial
fibrillation.

Author Affiliations: Departments of Epidemiology and Biostatistics (Drs van
der Hooft, Heeringa, Hofman, Witteman, Sturkenboom, and Stricker) and
Medical Informatics (Dr Sturkenboom), Erasmus University Medical Center,
Rotterdam, the Netherlands; Department of Respiratory Diseases, Ghent
University Hospital, Ghent, Belgium (Dr Brusselle); Inspectorate for Health
Care, The Hague, the Netherlands (Drs van der Hooft, Kingma, and Stricker);
and Department of Clinical Pharmacology, University of Groningen, Groningen,
the Netherlands (Dr Kingma).