Endocrine Abstracts

Introduction: Prednisolone is the standard treatment for most inflammatory conditions. However, it is also used in hormone replacement therapy in adrenal insufficiency (AI) for historical reasons or due to its longer half-life and once-daily application. Recent data indicate that daily prednisolone could be associated with lower bone mineral density than daily hydrocortisone in patients with AI. However, data on risk factors for cardiovascular disease in patients with AI treated with prednisolone are scarce, despite cardiovascular disease being the major cause of death in patients with AI. Therefore, we analyzed real-world data from the European Adrenal Insufficiency Registry (EU-AIR).

Design: EU-AIR with 19 centres across Germany, the Netherlands, Sweden and the UK started enrolling patients with AI in August 2012. Patients on dexamethasone or modified-release hydrocortisone were excluded from this analysis, as were patients with congenital adrenal hyperplasia. Patients receiving prednisolone (3–6 mg/day) or hydrocortisone (15–30 mg/day) were included, resulting in 50 patients on prednisolone and 909 on hydrocortisone. We performed a 1:3 matching regarding sex, age, duration of disease and aetiology of AI.

Results: After matching, we found significantly higher total cholesterol (6.3±1.6 vs 5.4±1.1 mmol/l; P<0.05) and LDL levels (3.9±1.4 vs 3.2±1.0 mmol/l; P<0.05) in 47 patients on prednisolone compared to 141 patients on hydrocortisone. HbA1c, HDL and triglyceride levels were not different between groups, neither were BMI (27.2±3.9 vs 27.8±5.3 kg/m²), systolic and diastolic blood pressure (128±18/78±9 vs 131±18/79±10 mmHg), and waist circumference (99.0±13.8 vs 96.1±13.9 cm). No differences in the frequency of hypertension or diabetes mellitus were detected between groups.

Conclusions: This is the first matched analysis comparing cardiovascular risk factors in patients with AI on prednisolone and hydrocortisone. Significantly higher LDL levels in patients treated with prednisolone than hydrocortisone could predict a higher relative risk of cardiovascular disease for these patients.