Glucocorticoids and cardiovascular and cerebrovascular events in polymyalgia rheumatica

Hilal Maradit Kremers, Megan S. Reinalda, Cynthia S. Crowson, John M. Davis, Gene G. Hunder, Sherine E. Gabriel

Research output: Contribution to journalArticlepeer-review

79 Scopus citations


Objective. To examine the effect of glucocorticoid use on the risk of various cardiovascular diseases in patients with polymyalgia rheumatica (PMR). Methods. We assembled a population-based incidence cohort of 364 patients with PMR first diagnosed between January 1, 1970 and December 31, 1999. Inclusion criteria were age ≥50 years, bilateral aching and morning stiffness involving at least 2 areas (neck, shoulders, hips, or proximal aspects of the thighs), and erythrocyte sedimentation rate (ESR) S40 mm/hour. In patients who fulfilled the first 2 criteria but had a normal ESR, a rapid response to low-dose glucocorticoids served as the third criterion. Patients were followed up until death or December 31, 2004. Cox models with time-dependent covariates were used to examine the association between glucocorticoid exposure and risk of myocardial infarction, heart failure, peripheral vascular disease, and cerebrovascular disease. Results. A total of 364 PMR patients (mean age 73 years, 67% women) were followed for a median of 7.6 years. During the disease course, 310 (85%) patients received glucocorticoids. After adjusting for age, calendar year, and ESR, patients who received glucocorticoids did not have a significantly higher risk for myocardial infarction, heart failure, peripheral vascular disease, or cerebrovascular disease (hazard ratio [95% confidence interval] 0.58 [0.29-1.18], 0.85 [0.45-1.54], 0.58 [0.24-1.40], and 0.65 [0.33-1.26], respectively) compared with those who did not receive glucocorticoids. In fact, a trend for a protective effect was seen. No significant association was observed between cumulative glucocorticoid dose and any of the outcomes (P = 0.39). Conclusion. In patients with PMR, treatment with glucocorticoids is not associated with an increased risk of cardiovascular diseases.

Original languageEnglish (US)
Pages (from-to)279-286
Number of pages8
JournalArthritis Care and Research
Issue number2
StatePublished - Mar 15 2007


  • Cardiovascular disease
  • Glucocorticoid therapy
  • Polymyalgia rheumatica

ASJC Scopus subject areas

  • Rheumatology


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