Chronic Corticosteroid CV Side Effects — EECC MCQ

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EasyCardiac PharmacologyChronic Corticosteroid CV Side EffectsEECC

A 55-year-old man on long-term corticosteroids for recurrent pericarditis asks about the side effects of chronic steroid use. His cardiologist wants to minimise the steroid dose. What are the key adverse effects of chronic corticosteroid therapy relevant to cardiovascular patients?

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Correct answer: E — Multisystem steroid toxicity and greater relapse risk

Chronic corticosteroid use carries significant CV-relevant adverse effects: (1) metabolic: weight gain (central obesity), hyperglycaemia/diabetes (steroid-induced), dyslipidaemia; (2) cardiovascular: hypertension (sodium/water retention), accelerated atherosclerosis; (3) musculoskeletal: osteoporosis (bone protection needed: calcium, vitamin D, consider bisphosphonate), myopathy; (4) immunosuppression: increased infection risk; (5) adrenal suppression: risk of adrenal crisis if abruptly withdrawn (must taper); (6) PERICARDITIS-SPECIFIC: corticosteroids increase the recurrence rate of pericarditis — the ESC 2025 Guidelines position steroids as SECOND-LINE (not first) precisely because of this. The recommended approach: (1) colchicine + NSAID/aspirin as first-line; (2) corticosteroids only when colchicine + NSAID fail or are contraindicated; (3) use lowest effective dose (0.2-0.5 mg/kg/day prednisolone); (4) very slow taper over months; (5) add steroid-sparing agents (anakinra/rilonacept) for corticosteroid-dependent recurrent pericarditis.

Reference: ESC (2025): Myocarditis/Pericarditis Guidelines: https://bnf.nice.org.uk/