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Inhaled corticosteroids reduce CV mortality

By Nigel Praities

Inhaled steroids can lower the risk of death from cardiovascular disease in women with asthma, a new study reveals.

The findings suggest the anti-inflammatory effects of steroids may have benefits far beyond asthma control, and encourage earlier use of the drugs, the researchers said.

They found a 63% reduced risk of cardiovascular death and a 42% reduced risk of all-cause death in women with asthma taking inhaled steroids over five years, compared with those who were not taking the drugs.

The Nurse's Health Study, in 2,671 US women aged 30 to 55 years with persistent asthma, is the first prospective study to show the association and supports the safety of inhaled steroids as initial therapy for asthma.

The researchers insisted the results were significant because in older women with asthma, cardiovascular disease was much more likely than asthma to cause their death.

The results were adjusted for age, asthma severity, smoking, history of disease and statin and aspirin use. They also found an apparent, but non-significant, reduction in the risk of cancer mortality.

Study leader Professor Carlos Camargo, associate professor of medicine at Harvard Medical School, said the study supported earlier findings that inhaled steroids could lower markers of systemic inflammation associated with cardiovascular disease.

‘Should family doctors feel more confident about initiating inhaled steroids earlier for asthma? Perhaps. If other studies confirm our results, we have identified a side-effect that may offset some of the concerns about the possible adverse effects of long-term ICS use.'

Inhaled steroids are recommended in NICE guidelines for all patients with chronic asthma, but there remain concerns that long-term use at high doses could cause problems such as cataracts, glaucoma and osteoporosis.

Dr Hilary Pinnock, a GP in Whitstable, Kent, and member of the General Practice Airways Group, said the study was an interesting addition to current evidence supporting the safety of inhaled steroids first-line for asthma.

‘We have to be careful about interpreting epidemiological studies, but it is encouraging when evidence from epidemiology confirms the evidence we have from other contexts.

‘This is another study that causes us to be confident about using ICS in appropriate doses,' she said.

The study was published online by the journal Chest.

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