High-dose inhaled corticosteroid use associated with increased cardiovascular risk in patients with asthma

<bold>BACKGROUND:</bold> Oral corticosteroids (OCS) associate with increased risk of cardiovascular disease (CVD). However, it is not clear whether use of high-dose inhaled corticosteroids (ICS) also links to increased CVD risk in asthma patients <bold>AIM:</bold> Using Swedish data from the NORdic Dataset for aSThmA Research (NORDSTAR) cohort we examined whether current high-dose ICS exposure is associated with CVD <bold>METHODS:</bold> This was an observational cohort study including asthma patients ≥18 years between 2009-19. A Cox regression model was used to examine the association between current ICS exposure (daily µg budesonide equivalent as a time-dependent predictor) and incident CVD using ICS-free patients as the reference group. Covariates included age, sex, and OCS dose <bold>RESULTS:</bold> At study enrollment, 468,940 asthma patients were included. Overall, 62,971 developed CVD. A dose-response relationship was identified between overall CVD risk and high-dose ICS: Hazard ratio (HR) 1.20 (95%CI 1.17-1.24) for daily ICS dose 800-1599 µg increasing to HR 1.63 (95%CI 1.53-1.74) with >2400µg. Likewise, the risk of several CVD subtypes were associated with high-dose ICS (800-1599 µg): ischemic heart disease HR 1.21 (95%CI 1.13-1.3); atrial fibrillation HR 1.34 (95%CI 1.25-1.43) and heart failure HR 1.53 (95%CI 1.43-1.63). HRs increased further for ICS >1600 and >2400 µg daily. No increase in risk was found with ICS doses below 800 µg daily <bold>CONCLUSION:</bold> We identified a dose-dependent risk of current high-dose ICS use on CVD onset. This highlights the importance of assessing CVD risk in patients with severe asthma. Further studies exploring this association are warranted.