Heart Disease & Prednisone?

Is Your Steroid Prescription Putting Your Heart at Risk?

Prednisone is a powerful corticosteroid widely used to treat inflammatory and autoimmune conditions. While it’s effective, its side effects—particularly those related to cardiovascular and metabolic health—can be serious. A recent seminar at Harvard Medical School, led by rheumatology expert Professor Naomi Patel, explored the risks associated with prednisone and strategies to manage them.

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The Hidden Risks of Prednisone

Prednisone affects nearly every system in the body, but the cardiovascular system is especially vulnerable. The Harvard seminar revealed that prednisone users face a 70% increased risk of developing cardiovascular diseases such as:

• Atrial fibrillation
• Heart failure
• Myocardial infarction (heart attack)
• Peripheral arterial disease

Even low doses can raise the risk, and the danger increases with higher dosages or long-term use.

Additionally, patients voiced concerns about weight gain, high cholesterol, and the development of type 2 diabetes—all of which are more likely in prednisone users.

Tools for Cardiovascular Risk Assessment

To address these concerns, the seminar introduced the ASCVD Risk Calculator, a tool used by healthcare providers to assess a person’s 10-year risk of heart disease. Based on the results:

• Individuals with a 10% or higher risk are typically advised to start statin therapy (e.g., Crestor or Lipitor).
• Those with a 7.5% to 10% risk may also benefit, depending on clinical judgment.

Using this tool can help patients make informed decisions about their cardiovascular health while on prednisone.

Prednisone and Weight Gain: Why It Happens

Weight gain is one of the most common and frustrating side effects. According to the seminar:

• 55% of long-term prednisone users experience weight gain.
• A significant portion gains more than 10% of their body weight.

Factors contributing to weight gain include:

• High glucocorticoid dosage
• Gender and age
• Smoking status
• Past exposure to prednisone or similar steroids

The underlying cause is prednisone’s effect on insulin and sugar metabolism, which promotes fat storage—particularly around the abdomen.

Lifestyle Strategies to Manage Weight

Fortunately, there are non-medication-based strategies that can help:

• Low glycemic diet: Helps control blood sugar and insulin spikes.
• Dietary counseling: Personalized guidance from a nutritionist or dietitian.
• Regular physical activity: Even light activities like walking can prevent weight gain and help maintain bone strength.

While mobility challenges from underlying diseases may make exercise difficult, every bit of movement counts—especially in counteracting prednisone’s effects.

Medication Options for Weight Management

The seminar also touched on GLP-1 receptor agonists, a class of medications increasingly used to aid in weight loss:

• Examples include Ozempic and Wegovy.
• Originally designed for diabetes, they help regulate appetite and metabolism.
• These medications carry some risks, like pancreatitis, but are generally safe for people taking prednisone.

Rheumatologists may consider these for patients struggling with prednisone-related weight gain.

Taking a Proactive Approach

Ultimately, the seminar emphasized the importance of proactive side effect management. Key recommendations include:

• Monitoring nutrient intake and maintaining a balanced diet
• Staying physically active
• Using medical tools like the ASCVD risk calculator
• Exploring both pharmaceutical and non-pharmaceutical strategies

Prednisone Checklist was also provided to help patients stay on track and reduce side effects. Sign up to download your own printable Prednisone Checklist.