RESEARCH - High-dose corticosteroids and the risk of atrial fibrillation

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Archives of Internal Medicine

Arch Intern Med. 2006;166:1016-1020

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; C. M. Witteman, PhD; J. Herre Kingma, MD,

PhD; Miriam C. J. M. Sturkenboom, PharmD, PhD; Bruno H. Ch. Stricker, MB,

PhD

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-intermediate-dose 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-intermediate-dose 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.

http://archinte.ama-assn.org/cgi/content/abstract/166/9/1016

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