Steroids Linked to Risk of Atrial Fibrillation

Researchers form the Erasmus University Medical Center (Rotterdam, Holland) conducted a nested case-control study within the Rotterdam Study, an ongoing population-based cohort study of 7,893 residents of Ommoord, a Rotterdam suburb. All participants were 55 or older at baseline in 1990.

Participants underwent follow-up examinations every four to five years, and corticosteroid use was tracked by computerized pharmacy records. The study endpoint was atrial fibrillation, death, or the end of the study period (January 1, 2000). During the follow-up, the researchers identified 385 patients with new onset atrial fibrillation, who were included in the analysis. Those cases were compared with 6,365 controls.

High-dose corticosteroid use was associated with an odds ratio (OR) of 6.07 for atrial fibrillation whereas low-intermediate-dose use was not. Because patients taking high-dose corticosteroids had other risk factors for atrial fibrillation, the authors performed additional age- and sex-adjusted analysis, examining the effects among a high-dosage group, a high-dose asthma/ chronic obstructive pulmonary disease (COPD) group, and an "other disease” group.

They then divided the cases into two groups--those with zero to two risk factors for atrial fibrillation and those with three or more risk factors--and analyzed the data again. Using that risk-stratified model, they found that among patients with zero to two risk factors who took high-dose corticosteroids the OR was 7.09, while in those with three or more atrial fibrillation risk factors the OR was 6.09. The results were reported in the May 9, 2006, issue of the Archives of Internal Medicine.

Lead author Dr. Cornelis S. van der Hooft and colleagues concluded that patients on high-dose corticosteroid therapy should be closely monitored with both clinical examination and electrocardiogram (ECG) analysis before and after therapy. Such monitoring, they wrote, "could increase the chance to diagnose and treat this serious arrhythmia as early as possible.”



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Erasmus University Medical Center