Glucocorticoid Use and Risk of Atrial Fibrillation or Flutter

Abstract

Glucocorticoids are widely used in the treatment of inflammatory and autoimmune diseases, such as chronic obstructive pulmonary disease (COPD), asthma, rheumatoid arthritis (RA), connective tissue diseases, inflammatory bowel diseases, chronic hepatitis, glomerulonephritis, and malignant neoplasms, as well as in organ transplantations.¹ Glucocorticoid use has several adverse effects that are established risk factors for atherosclerosis, such as hypertension, sodium and fluid retention, diabetes mellitus, and dyslipidemia.^2,3 Treatment with high-dose glucocorticoids has been reported to increase the risk of myocardial infarction, stroke, and heart failure.⁴ Atrial fibrillation is a common cardiac arrhythmia whose prevalence is above 10% in men 80 years or older.⁵ It is associated with increased mortality and morbidity, mainly because of a 3- to 4-fold increased risk of ischemic stroke.⁶ The existing literature with regard to glucocorticoid use and atrial fibrillation consists of 2 case reports and 2 case-control studies. Both case reports described episodes of atrial fibrillation after methylprednisolone pulse therapy.^7,8 The 2 case-control studies, which involved 385 and 468 atrial fibrillation cases from the Netherlands and the United Kingdom, respectively, found an increased risk of atrial fibrillation among users of systemic glucocorticoids.^9,10 However, the interpretation of these studies was hampered by restriction to COPD patients,¹⁰ incomplete participation,⁹ and relatively small sample size which yielded statistically imprecise risk estimates for subgroups.⁹