Risk of cardiovascular events in people prescribed glucocorticoids with iatrogenic Cushing's syndrome: cohort study
Risk of cardiovascular events in people prescribed glucocorticoids with iatrogenic Cushing's syndrome: cohort study
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DOI：
10.1136/bmj.e4928
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发表时间：
2012-07-30
影响因子：
105.7
通讯作者：
Nazareth, Irwin
中科院分区：
文献类型：
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作者：
Fardet, Laurence;Petersen, Irene;Nazareth, Irwin
目的研究在糖皮质激素治疗过程中表现出医源性库欣综合征的患者是否存在心血管事件增加的风险。设计队列研究。设置424个英国全科诊所，为健康改善网络数据库做出贡献。参与者为开全身性糖皮质激素处方并诊断为医源性库欣综合征的患者（n=547）和两个对照组：其中3231例接受了糖皮质激素治疗，但未诊断为医源性库欣综合征，3282例未接受全身性糖皮质激素治疗。主要结果测量在诊断为医源性库欣综合征后一年内或随机选择日期后心血管事件的发生率，结果341例患者共发生心血管事件417例次，其中心血管事件发生率为100%。仅考虑患者的首起事件（冠心病n=177，心力衰竭n=101，缺血性卒中n=63），每100人年心血管事件的发生率为15.1（95%置信区间11.8 - 18.4）在那些处方糖皮质激素并诊断为医源性库欣综合征的患者中，未诊断为医源性库欣综合征而使用糖皮质激素者为6.4（5.5 ~ 7.3），未使用糖皮质激素者为4.1（3.4 ~ 4.8）。在校正性别、年龄、糖皮质激素使用强度、基础疾病、吸烟状况、阿司匹林、糖尿病药物、抗高血压药物、降脂药物或口服抗凝药物的多变量分析中，医源性库欣综合征与心血管事件之间的关系很强（冠心病的校正风险比为2.27（95%置信区间为1.48至3.47），（心力衰竭2.41 - 5.90），缺血性脑血管事件2.23（0.96 - 5.17））。任何心血管事件的调整后的危险比为4.16（2.98至5.82）时，组处方糖皮质激素和医源性库欣综合征相比，组不开糖皮质激素。结论人谁使用糖皮质激素和医源性库欣综合征应积极有针对性的心血管危险因素的早期筛查和管理。
Objective To investigate whether there is an increased risk of cardiovascular events in people who exhibit iatrogenic Cushing's syndrome during treatment with glucocorticoids.Design Cohort study.Setting 424 UK general practices contributing to The Health Improvement Network database.Participants People prescribed systemic glucocorticoids and with a diagnosis of iatrogenic Cushing's syndrome (n=547) and two comparison groups: those prescribed glucocorticoids and with no diagnosis of iatrogenic Cushing's syndrome (n=3231) and those not prescribed systemic glucocorticoids (n=3282).Main outcome measures Incidence of cardiovascular events within a year after diagnosis of iatrogenic Cushing's syndrome or after a randomly selected date, and association between iatrogenic Cushing's syndrome and risk of cardiovascular events.Results 417 cardiovascular events occurred in 341 patients. Taking into account only the first event by patient (coronary heart disease n=177, heart failure n=101, ischaemic stroke n=63), the incidence rates of cardiovascular events per 100 person years at risk were 15.1 (95% confidence interval 11.8 to 18.4) in those prescribed glucocorticoids and with a diagnosis of iatrogenic Cushing's syndrome, 6.4 (5.5 to 7.3) in those prescribed glucocorticoids without a diagnosis of iatrogenic Cushing's syndrome, and 4.1 (3.4 to 4.8) in those not prescribed glucocorticoids. In multivariate analyses adjusted for sex, age, intensity of glucocorticoid use, underlying disease, smoking status, and use of aspirin, diabetes drugs, antihypertensive drugs, lipid lowering drugs, or oral anticoagulant drugs, the relation between iatrogenic Cushing's syndrome and cardiovascular events was strong (adjusted hazard ratios 2.27 (95% confidence interval 1.48 to 3.47) for coronary heart disease, 3.77 (2.41 to 5.90) for heart failure, and 2.23 (0.96 to 5.17) for ischaemic cerebrovascular events). The adjusted hazard ratio for any cardiovascular event was 4.16 (2.98 to 5.82) when the group prescribed glucocorticoids and with iatrogenic Cushing's syndrome was compared with the group not prescribed glucocorticoids.Conclusion People who use glucocorticoids and exhibit iatrogenic Cushing's syndrome should be aggressively targeted for early screening and management of cardiovascular risk factors.