Risk of cardiovascular disease while on Prednisone.

Patients with systemic inflammatory conditions such as
PMR should be evaluated for cardiac risk. It is definitely
elevated significantly in many rheumatic conditions.
Diet and stations may mitigate our risk.
It may be hard to determine how much steroids contribute as more severe chronic inflammation may be treated with more steroid. DM type II and hypertension
are known risks with steroid therapy.
I first experienced cardiac conduction disorder after
my PMR.

Statins not stations!

I had and still have a chronic inflammatory disease for nearly 20 years before PMR was diagnosed. My flares were treated with a high dose of prednisone followed by a fast taper. I never had any problems tapering off prednisone. In fact, my ophthalmologist who prescribed prednisone for uveitis said I was "skilled" with prednisone tapers. I could go from 60 mg to zero in a month or two to achieve remission of uveitis. I failed to mention the mysterious back and joint pain I was having whenever uveitis flared up. The pain had a way of disappearing after prednisone was used to treat uveitis.

I never had a primary care doctor, rheumatologist, cardiologist or any other -ologist except for my ophthalmologist during these 20 years. I stopped seeing a neurologist after a couple of years. I decided they had nothing useful for the treatment of trigeminal neuralgia (TN) because prednisone wasn't used to treat it. I took massive amounts of prednisone on an intermittent short term basis to achieve a temporary remission of flares of uveitis, TN, back pain and other large joint pain. I never needed prednisone on a long term basis until PMR was diagnosed.

A rheumatologist got involved when PMR was diagnosed. I wasn't able to taper off Prednisone quickly for 12 years after being diagnosed with PMR. My rheumatologist didn't want me to taper off quickly and insisted I needed prednisone for a year or two. . Many -ologists followed in rapid succession for "idiopathic things." This included a cardiologist for my blood pressure and cardiac problems and both a pulmonologist and a hematologist for my idiopathic pulmonary embolism.

I got off prednisone 3 years ago after taking prednisone for 12 years for PMR. I have stopped all three of my BP medications, atorvastatin and warfarin in the past three years. Apparently my risk of cardiovascular disease has decreased since I tapered off prednisone. They say my cardiovascular risk will decrease more with diet and exercise and if I can continue to reduce my weight.

I'm still being treated for PMR but not with prednisone anymore.

This article does not really surprise me. Prednisone is known to affect the cardiovascular system and low dose only lessens the risk, does not remove it. There is no free lunch when it comes to medications for PMR. These type of articles do tend to sensationalize the risks found by the studies. Risk for serious CV disorders for people taking more than 25 mg prednisone went up over sixfold, from 1.4% to 8.9%. A doubling of risk for people taking less than 5 mg would increase it from 1.4 to 2.8%. Diet, exercise and weight have much more influence than that. Making modest lifestyle changes could more than offset the 1.4% increase for those taking less than 5 mg and perhaps even the group taking more than 25 mg.
Before I got PMR I had some irregular heartbeats, usually induced by exercise. I had a cardiac workup and was told that the abnormal beats I had were not frequent enough to cause problems and I did not need to have anything done. After I got on prednisone the rheumatologist looked shocked when he felt my pulse. I was having irregular beats constantly though I felt fine. They were called PVC's and trigeminy, somewhat serious. He was worried that I would develop atrial fibrillation. I learned to recognize those types of beats when I took my own pulse. I monitored it daily and as soon as I got to lower doses of prednisone I didn't detect those beats any more. I was not about to add cardiac meds which might not even help and it wasn't even suggested that I see a cardiologist. If I died of a heart attack so be it. I was willing to take the risk since prednisone improved my life so much.

This article is very informative and credible (#of patients is a healthy 89,000+, over a years long period).
After starting pred, I began to have new symptoms - tachycardia, and shortness of breath. My rheumatologist sent me for an echo cardiogram, and from there I saw a cardiologist. He actually told me more about PMR and pred than the rheumatologist.
The echo was fine, but the EKG showed a couple of abnormalities, enough to warrant a stress test.
The NIH study revealed new onset cardiac conditions even on low dose pred (5mg). 🤔
Thanks for the article. Preciate it.

Are you on a biologic? If so, any mean side effects? My rheumatologist considered this if the pred wasn't effective or if I have problems with the taper.

Yes ... I thought it was a quality study given the sample size and years involved. It is hard to evaluate how the study was actually done but most people don't care about that.

I think people forget that PMR/GCA aren't the only conditions that prednisone is used for. PMR/GCA patients are a relatively small group of older people. The numbers are more staggering when more inflammatory conditions are included in the study. Many inflammatiory conditions afflict younger people. The average age of patients in this study was 56 so more younger people are included than the typical PMR/GCA patient. "New onset" cardiovascular disease is a big deal for younger people.

Yes ... I started Actemra (tocilizumab) more than five years ago on January 1st 2019. I purposely waited for the New Year to do my first injection. I wasn't doing well back then after 12 years of prednisone for PMR. Granted ... I had other problems in addition to PMR. It is difficult to find PMR patients who don't have additional medical problems!

I would point to my medication list as an objective evaluation of side effects since Actemra was started. On prednisone, I was taking three blood pressure medications, atorvastatin, and warfarin just for my cardiovascular problems. I wasn't able to discontinue all these medications as soon as I got off prednisone. However, I stopped warfarin last month and now I am off all these medications in addition to being off prednisone.

It was funny because I had been on atorvastatin for years ... soon after PMR was diagnosed. Nobody ever blamed PMR for causing my high cholesterol levels. After a couple years on Actemra, my cholesterol levels dropped. There was a concern that my cholesterol levels were too low. My rheumatologist joked because elevated cholesterol levels were a possible side effect of Actemra. He said I made a mockery of that notion as he stopped atorvastatin. He said my CK levels were getting high so he was getting worried about statin induced myopathy. My CK level was normal the last time it was checked.

I have more frequent lab monitoring on Actemra compared to when I was on prednisone. Almost all my labs are normal now. When I was on Prednisone my labs were always messed up.

Unfortunately, my inflammation markers crept up when the interval between my Actemra infusion was stretched to 7 weeks instead of every 4 weeks. I didn't have any huge amount of pain but my rheumatologist said, based on my inflammation markers, I still need Actemra.

This article and all your comments are so validating for me. I started prednisone at 40, then 30 mg in February, and within weeks developed PVCs and ventricular tachycardia with daily dizziness and shortness of breath. I have undergone extensive workup, including wearing a monitor for ten days, echocardiogram , stress test (which showed ischemia) and finally an angiogram a month ago. Everyone was very surprised that it showed clear coronary arteries. I was prepared for several stents to be placed. I have believed from day one that my arrhythmia was caused by prednisone use. My cardiologist doesn’t seem convinced. I see her again in six months, and she has offered me another two week monitor before then if I want. But….I am now on 12.5 mg prednisone, and feel much better.