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Higher CV risk exists with prednisolone in adrenal insufficiency

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Adults with adrenal insufficiency prescribed prednisolone therapy had higher levels of total and LDL cholesterol vs. patients prescribed hydrocortisone, according to study findings presented at the European Congress of Endocrinology.

“Data on risk factors for cardiovascular disease in patients with [adrenal insufficiency] treated with prednisolone are scarce, despite cardiovascular disease being the major cause of death in patients with [adrenal insufficiency],” Marcus Quinkler, MD, of Endocrinology in Charlottenburg in Berlin, and colleagues wrote. “Therefore, we analyzed real-world data from the European Adrenal Insufficiency Registry (EU-AIR).”

Quinkler and colleagues analyzed EU-AIR data from 959 patients with adrenal insufficiency prescribed prednisolone (3 to 6 mg daily; n = 50) or hydrocortisone (15 to 30 mg daily; n = 909). Patients prescribed dexamethasone or modified-release hydrocortisone and patients with congenital adrenal hyperplasia were excluded from the analysis. Patients were matched 1:3 based on age, sex, duration of disease and etiology of adrenal insufficiency.

Of the 50 patients prescribed prednisolone, 47 had higher total and LDL cholesterol vs. 141 patients prescribed hydrocortisone (total cholesterol: 6.3 mmol/L vs. 5.4 mmol/L; P < .05; LDL: 3.9 mmol/L vs. 3.2 mmol/L; P < .05). There were no between-group differences for HbA1c, HDL cholesterol or triglyceride levels, or for BMI, diastolic blood pressure or waist circumference. There were also no between-group differences in frequency of hypertension or diabetes.

“This is the first matched analysis comparing CV risk factors in patients with [adrenal insufficiency] on prednisolone and hydrocortisone,” the researchers wrote. “Significantly higher LDL [cholesterol] levels in patients treated with prednisolone than hydrocortisone could predict a higher relative risk of CVD for these patients.” – by Regina Schaffer

Reference:

Quinkler M, et al. Abstract OC1.3. Presented at: European Congress of Endocrinology; May 28-31, 2016; Munich.

Disclosure: Endocrine Today was unable to determine any relevant financial disclosures.