MRC General Practice Research Framework, University College London Medical School, London, UK.
BMJ. 2012 Jul 30;345:e4928. doi: 10.1136/bmj.e4928.
To investigate whether there is an increased risk of cardiovascular events in people who exhibit iatrogenic Cushing's syndrome during treatment with glucocorticoids.
Cohort study.
424 UK general practices contributing to The Health Improvement Network database.
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).
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.
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.
People who use glucocorticoids and exhibit iatrogenic Cushing's syndrome should be aggressively targeted for early screening and management of cardiovascular risk factors.
研究在接受糖皮质激素治疗期间出现医源性库欣综合征的患者发生心血管事件的风险是否增加。
队列研究。
向 The Health Improvement Network 数据库贡献信息的 424 家英国普通诊所。
接受全身糖皮质激素治疗且诊断为医源性库欣综合征的患者（n=547）和两个对照组：接受糖皮质激素治疗且无医源性库欣综合征诊断的患者（n=3231）和未接受全身糖皮质激素治疗的患者（n=3282）。
诊断为医源性库欣综合征或随机选定日期后 1 年内发生心血管事件的发生率，以及医源性库欣综合征与心血管事件风险之间的关系。
341 名患者发生了 417 例心血管事件。仅考虑每位患者的首次事件（冠心病 n=177，心力衰竭 n=101，缺血性脑卒中 n=63），接受糖皮质激素治疗且诊断为医源性库欣综合征患者的心血管事件发生率为每 100 人年 15.1（95%置信区间 11.8 至 18.4），接受糖皮质激素治疗且无医源性库欣综合征诊断的患者为 6.4（5.5 至 7.3），未接受糖皮质激素治疗的患者为 4.1（3.4 至 4.8）。在校正性别、年龄、糖皮质激素使用强度、基础疾病、吸烟状态以及阿司匹林、糖尿病药物、抗高血压药物、降脂药物或口服抗凝药物使用情况后，医源性库欣综合征与心血管事件之间的关系很强（校正后的冠心病危险比为 2.27（95%置信区间 1.48 至 3.47），心力衰竭为 3.77（2.41 至 5.90），缺血性脑血管事件为 2.23（0.96 至 5.17））。与未接受糖皮质激素治疗的患者相比，接受糖皮质激素治疗且出现医源性库欣综合征的患者发生任何心血管事件的校正危险比为 4.16（2.98 至 5.82）。
使用糖皮质激素且出现医源性库欣综合征的患者应积极进行心血管危险因素的早期筛查和管理。
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