Cardiovascular risk profile of low-dose prednisolone and its effect on the quality of life in patients with adrenal insufficiency: the HYPER-AID observational study

Emmanuel Ssemmondo; Katharine Lazarus; Milly Newham; Kavita Narula; Zin Htut; Thozhukat Sathyapalan; Sirazum Choudhury; Karim Meeran

doi:10.1530/endoabs.109.OC5.5

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Endocrine Abstracts (2025) 109 OC5.5 | DOI: 10.1530/endoabs.109.OC5.5

SFEBES2025 Oral Communications Adrenal and Cardiovascular (6 abstracts)

Cardiovascular risk profile of low-dose prednisolone and its effect on the quality of life in patients with adrenal insufficiency: the HYPER-AID observational study

Emmanuel Ssemmondo ^1,2 , Katharine Lazarus ^3,4 , Milly Newham ² , Kavita Narula ^3,4 , Zin Htut ^3,4 , Thozhukat Sathyapalan ^1,2 , Sirazum Choudhury ^3,4,5 & Karim Meeran ^3,4

Author affiliations

¹University of Hull, Hull, United Kingdom; ²Hull University Teaching Hospital NHS Trust, Hull, United Kingdom; ³Imperial College London, London, United Kingdom; ⁴Imperial College Healthcare NHS Trust, London, United Kingdom; ⁵Department of Clinical Biochemistry Northwest London Pathology, London, United Kingdom

Aim: To assess the cardiovascular risk of low dose prednisolone in patients with adrenal insufficiency (AI), and how switching from hydrocortisone to prednisolone affects their quality of life (QOL).

Methods: In this prospective observational study, patients with AI were switched from hydrocortisone to 2-4 mg of prednisolone and followed up for 4 months. We assessed cardiovascular risk using blood pressure, waist and hip circumferences, lipid profile and C-reactive protein. QOL was assessed using a customized modified SF-36 questionnaire. We compared baseline and follow-up means using paired t-test.

Results: Sixty-two participants were enrolled, of which 48 completed the study. The mean (SD) age at enrolment was 54.5±13 years. Twenty-seven (56.3%) were female while 8 (16.8%) had primary AI. The mean duration on glucocorticoids was 11.4±8.6 years. At follow-up, we observed a significant reduction in weight from 90.6 kg to 89.6 kg (P=0.007). There was a significant reduction in systolic blood pressure (BP) of up to 6mmHg (P=0.027) but not the diastolic BP. There was no difference in the ratios of waist to hip circumference (P=0.183). The use of prednisolone was associated with no changes in LDL-cholesterol, total cholesterol, HDL, non-HDL, triglycerides or CRP (P>0.05 for all). We observed an increase in subjective energy scores as well as total quality of life scores (P=0.003 and P=0.019 respectively). There were however no changes in the subjective general health, wellbeing and nausea scores. Patients reported prednisolone to be more convenient compared to hydrocortisone (P=0.002).

Conclusion: Prednisolone has similar cardiovascular risk profile to hydrocortisone. The reduction in weight and systolic blood pressure, convenience, the improvement in energy levels and subjective general health offer additional advantages over hydrocortisone.