전신코르티코스테로이드 투여 후 급성심근경색증 발생위험에 대한 후향적 코호트연구

초록

Objectives : Corticosteroids are widely prescribed potent anti-inflammatory drugs. Several reports raised the risk of cardiovascular diseases associated to the current use and high dose of corticosteroids. We performed a retrospective cohort analysis to evaluate the risk of acute myocardial infarction (AMI) associated with the use of corticosteroids in Korea. Methods : We used the Korea Health Insurance Review and Assessment Service-National Inpatients Sample (HIRA-NIS) database. The study was conducted on 20 years or older who prescribed corticosteroids between April 2009 and September 2009. Corticosteroids users were followed until they were diagnosed with acute myocardial infarction, until death, or until the end of the study. The Cox proportional hazards model was used to calculate hazard ratios (HRs) and their 95% confidence intervals (CIs), while adjusting for comedications and comorbidities. Results : AMI was reported in 737 of 104,801 corticosteroid users (14 per 1,000 person-years). Compared with prednisolone users, the HR of AMI was 1.26 (95% CI=1.01-1.57) in methylprednisolone users. High dose user of prednisolone-equivalent mean daily dose was associated with an increased risk of AMI (adjusted HR 11.65, 95% CI=8.18-16.60), which was consistent among male, female, aged 40-64, 65 over, and patients with or without rheumatoid arthritis, asthma/chronic obstructive pulmonary disease, coronary heart disease, NSAIDs, and anticoagulants. Conclusion : Based on our study results, the risk of AMI increased in methylprednisolone users compared with prednisolone users. Further study needs to perform using for long-term data and high dose users of corticosteroids needs careful monitoring for AMI occurrence.

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