CORTICOSTEROIDS - DO THEY DAMAGE THE CARDIOVASCULAR-SYSTEM

Since their introduction for the treatment of rheumatoid arthritis, co rticosteroids have become widely used as effective agents in the contr ol of inflammatory diseases. Although there have been undoubted benefi ts upon mortality in diseases such as systemic lupus erythematosus, ma ny patients survive only to suffer a high incidence of premature ather osclerosis. There is also evidence of increased rates of vascular mort ality in other corticosteroid-treated diseases, such as rheumatoid art hritis, reversible airways obstruction and transplant recipients. Poss ible mechanisms of damage include elevated blood pressure, impaired gl ucose tolerance, dyslipidaemia, and imbalances in thrombosis and fibri nolysis. This paper reviews the clinical evidence supporting the conte ntion that there is an excess cardiovascular mortality in steroid-trea ted patients and the underlying mechanisms, and points to further area s of research.