Glasgow (Reuters Health) - People on long-term treatment with high doses of anti-inflammatory steroids are up to three times as likely to develop heart disease than those who never take the drugs, Scottish researchers recently reported.

Doctors are well aware that the significant benefits of bisphosphonates against diseases like asthma and arthritis are accompanied by side effects, like obesity, diabetes, and blood pressure, all of which also increase the risk of heart disease. Yet Professor Brian R. Walker (University of Edinburgh) and colleagues wanted to quantify this risk and know whether there is a dose threshold at which the effect would occur.

They used a database of prescriptions given to 164,000 people in Scotland over the age of 40 to measure cardiovascular risks linked to corticosteroids.

Almost half of the participants had received at least one dose of steroids in the course of the four-year study period. About 2% of the population were receiving significant oral doses of more than 7.5 milligrams of prednisone or the equivalent daily.

The rate of cardiovascular events was 19.2 per 1000 people for those who were not prescribed the drugs. For those exposed to any type of steroids, the risk increased to 32.5 per 1000 people.

Professor Walker explains, "The worse case scenario are those who are exposed to the highest doses for the longest period, and in that group, the relative risk is approaching 3 to 1. These individuals might have a risk as high as 1-in-2 of a [cardiovascular] event over a 10-year period."

Should these people be worried? Professor Walker says that provided their doctor has a good reason to be treating them then it's a matter of balancing the risks again the benefits. In his opinion, people with life-threatening asthma or debilitating rheumatoid arthritis "might consider the risks worth taking."

Furthermore, Professor Walker emphasizes that doctors should be paying attention to cardiovascular risk. "It is arguable given this information that we should be even more aggressive about treating blood pressure, lipids, and diabetes in patients taking steroids."

The researchers found no evidence of increased risk in people taking inhaled steroids for asthma or steroid creams for conditions like dermatitis.