High-dose inhaled corticosteroid use associated with increased cardiovascular risk in patients with asthma

<bold>BACKGROUND:</bold> Oral corticosteroids (OCS) associate with increased risk of cardiovascular disease (CVD). However, it is not clear whether use of high-dose inhaled corticosteroids (ICS) also links to increased CVD risk in asthma patients <bold>AIM:</bold> Using Swedish data from the NORdic Dataset for aSThmA Research (NORDSTAR) cohort we examined whether current high-dose ICS exposure is associated with CVD <bold>METHODS:</bold> This was an observational cohort study including asthma patients ≥18 years between 2009-19. A Cox regression model was used to examine the association between current ICS exposure (daily µg budesonide equivalent as a time-dependent predictor) and incident CVD using ICS-free patients as the reference group. Covariates included age, sex, and OCS dose <bold>RESULTS:</bold> At study enrollment, 468,940 asthma patients were included. Overall, 62,971 developed CVD. A dose-response relationship was identified between overall CVD risk and high-dose ICS: Hazard ratio (HR) 1.20 (95%CI 1.17-1.24) for daily ICS dose 800-1599 µg increasing to HR 1.63 (95%CI 1.53-1.74) with >2400µg. Likewise, the risk of several CVD subtypes were associated with high-dose ICS (800-1599 µg): ischemic heart disease HR 1.21 (95%CI 1.13-1.3); atrial fibrillation HR 1.34 (95%CI 1.25-1.43) and heart failure HR 1.53 (95%CI 1.43-1.63). HRs increased further for ICS >1600 and >2400 µg daily. No increase in risk was found with ICS doses below 800 µg daily <bold>CONCLUSION:</bold> We identified a dose-dependent risk of current high-dose ICS use on CVD onset. This highlights the importance of assessing CVD risk in patients with severe asthma. Further studies exploring this association are warranted.

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Published
2024-09-14
DOI
https://doi.org/10.1183/13993003.congress-2024.pa4495
Primary Topic
Asthma and respiratory diseases
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article
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article

High-dose inhaled corticosteroid use associated with increased cardiovascular risk in patients with asthma

Asger Sverrild, Arja Viinanen, Anna von Bülow, Olivia Ernstsson et al.
Asthma and respiratory diseases
article

High-dose inhaled corticosteroid use associated with increased cardiovascular risk in patients with asthma

Asger Sverrild, Arja Viinanen, Anna von Bülow, Olivia Ernstsson, Patrik Sandin, Helena Bäckman, Christer Janson, Jussi Karjalainen, Hannu Kankaanranta, Alan Altraja, Pinja Ilmarinen, Paula Kauppi, Susanne Hansen, Apostolos Bossios, Charlotte Suppli Ulrik, Ghada F. R. Hassan, Valentyna Yasinska, Kirk Geale, Celeste Porsbjerg, Lauri Lehtimäki, Vibeke Backer, Alexandra Cooper, Bernt Bøgvald Aarli, Maritta Kilpeläinen, Sylvia Packham
article en

Abstract

<bold>BACKGROUND:</bold> Oral corticosteroids (OCS) associate with increased risk of cardiovascular disease (CVD). However, it is not clear whether use of high-dose inhaled corticosteroids (ICS) also links to increased CVD risk in asthma patients <bold>AIM:</bold> Using Swedish data from the NORdic Dataset for aSThmA Research (NORDSTAR) cohort we examined whether current high-dose ICS exposure is associated with CVD <bold>METHODS:</bold> This was an observational cohort study including asthma patients ≥18 years between 2009-19. A Cox regression model was used to examine the association between current ICS exposure (daily µg budesonide equivalent as a time-dependent predictor) and incident CVD using ICS-free patients as the reference group. Covariates included age, sex, and OCS dose <bold>RESULTS:</bold> At study enrollment, 468,940 asthma patients were included. Overall, 62,971 developed CVD. A dose-response relationship was identified between overall CVD risk and high-dose ICS: Hazard ratio (HR) 1.20 (95%CI 1.17-1.24) for daily ICS dose 800-1599 µg increasing to HR 1.63 (95%CI 1.53-1.74) with >2400µg. Likewise, the risk of several CVD subtypes were associated with high-dose ICS (800-1599 µg): ischemic heart disease HR 1.21 (95%CI 1.13-1.3); atrial fibrillation HR 1.34 (95%CI 1.25-1.43) and heart failure HR 1.53 (95%CI 1.43-1.63). HRs increased further for ICS >1600 and >2400 µg daily. No increase in risk was found with ICS doses below 800 µg daily <bold>CONCLUSION:</bold> We identified a dose-dependent risk of current high-dose ICS use on CVD onset. This highlights the importance of assessing CVD risk in patients with severe asthma. Further studies exploring this association are warranted.

Uppsala University (SE), Statistics Sweden (SE), Karolinska University Hospital (SE), University of Helsinki (FI), Uppsala University Hospital (SE), Seinäjoki University of Applied Sciences (FI), Helsinki University Hospital (FI), Haukeland University Hospital (NO), Frederiksberg Hospital (DK), Bispebjerg Hospital (DK), Hvidovre Hospital (DK), Turku University Hospital (FI), Tartu University Hospital (EE), Rigshospitalet (DK), Karolinska Institutet (SE), Sanofi (Finland) (FI), 358 (Finland) (FI), Tampere University Hospital (FI), Tampere University (FI), Quantify Research (Sweden) (SE), Umeå University (SE)
Good health and well-being
Openalex Percentile: Top 72%
Asthma and respiratory diseases
DOISourceOpenAlex
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