Associations Between Local Corticosteroid Use, Metabolic Syndrome, and Body Mass Index in a Large Population-Based Cohort Study: The Lifelines Cohort Study

Presentation Number: OR03-2
Date of Presentation: April 2nd, 2017

Mesut Savas*1, Vincent L. Wester1, Taulant Muka1, Erica L.T. van den Akker1, Jenny A. Visser1, Sandra N. Slagter2, Bruce H.R. Wolffenbuttel2, Oscar H. Franco1 and Elisabeth F.C. van Rossum1
1Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands, 2University of Groningen, University Medical Center Groningen, Groningen, Netherlands


Introduction - Synthetic corticosteroids (CS) are potent anti-inflammatory drugs with multiple indications and many administration forms for both systemic and local disorders. Use of systemic CS is well-known to induce adverse cardiometabolic alterations potentially leading to the metabolic syndrome (MetS). Although evidence is accumulating that local CS have considerable systemic effects, their effect on cardiometabolic factors in the general population remains unclear. Hence, we assessed the associations between overall CS use and specific CS types with MetS and body mass index (BMI) in a large population-based cohort study.

Methods - We included information on 140.879 participants (mean age 44.8 years, 58.5% females) of the population-based Lifelines cohort study. Drug use was evaluated with a self-reported questionnaire and a visual drug container inspection during site visit. Drugs were coded according to the WHO ATC classification system. Data on BMI, waist circumference, systolic and diastolic blood pressure, and fasting serum levels of triglycerides, HDL-cholesterol, and glucose were complete for all subjects. MetS was defined according to the (2009) harmonized Joint Interim Statement criteria. Analyses were adjusted for multiple covariates including amongst others sex, age, ethnicity, education level, smoking, alcohol use, physical activity, menstrual status, cardiovascular disease, other comorbidities, and use of potential weight-inducing drugs.

Results - A total of 10.9% of the study population was currently using CS, which comprised predominantly the use of only local administration forms (95.4%). Overall, CS users had higher odds of having MetS (odds ratio (OR) 1.11 (95% CI, 1.06-1.18), P<.001) and increased BMI (+0.31 kg/m2 (0.24-0.39), P<.001) compared to non-users. In the sex-stratified analyses (Pint<.001), we observed markedly stronger associations in women (MetS: OR 1.21 (1.12-1.31), BMI: +0.43 (0.32-0.54)) compared to men (MetS: OR 0.98 (0.90-1.06), BMI: +0.04 (-0.07-0.14)). According to the CS administration forms, both users of systemic and only local forms had increased odds for MetS (OR 1.24 (1.01-1.53) and OR 1.11 (1.05-1.17), respectively). The associations in users of only local CS were mainly driven by participants using inhaled CS, who had a higher likelihood for MetS (OR 1.23 (1.13-1.34)) and increased BMI (+0.65 kg/m2(0.53-0.78), both P<.001) compared to non-users.

Conclusions - Overall use of CS, and particularly inhaled types, is associated with higher risk of metabolic syndrome and higher BMI. Since the inhaled CS forms are the main group of prescribed CS this might be a substantial risk to public health, especially in females. Further studies are needed to confirm these findings and evaluate the direction of causality and mechanisms behind these associations.


Nothing to Disclose: MS, VLW, TM, ELTV, JAV, SNS, BHRW, OHF, EFCV