Glucocorticoids and the Cardiovascular System: State of the Art

Udi      Nussinovitch; Jozelio      Freire de Carvalho; Rosa      Maria R. Pereira; Yehuda      Shoenfeld

doi:10.2174/138161210793797870

Abstract

Glucocorticoids (GC) are drugs commonly used, by approximately 1% of the total adult population as anti-inflammatory and immunosuppressive therapies for asthma, inflammatory bowel disease, dermatological, ophthalmic, neurological, and rheumatic autoimmune diseases. Supporting evidence exists of GC use in both immune mediated and non-immune mediated heart disease. The molecular mechanisms by which GC induces immune-modulation and direct cardioprotection, are complex and not fully understood. We review herein, the current knowledge of GC use in various immune-mediated or non-immune mediated cardiovascular conditions. GC have been investigated in autoimmune, inflammatory and idiopathic heart diseases such as atrio-ventricular conduction abnormalities, rheumatic fever, myocarditis, dilated cardiomyopathy, Churg-Strauss syndrome, Kawasaki disease and sarcoidosis. GC therapy has been studied in non-autoimmune and non-inflammatory indications such as acute myocardial infarction, angina, postpericardiotomy syndrome and other pericardial diseases, endocarditis and cardiac amyloidosis, as well as in invasive cardiology, coronary interventions, and cardiopulmonary- bypass surgery. Despite GCs role as natural, physiologic regulators of the immune system, cardiovascular adverse outcomes may occur. Some of the well-known side effects of GC therapy involve bone, metabolic, and cardiovascular systems and include osteoporosis, fractures, dyslipidemia, diabetes, obesity, and hypertension.

Keywords: Cardiovascular disease, glucocorticoid, myocardial infarction, cardiopulmonary bypass, vasospastic angina, Kawasaki disease, Churg-Strauss syndrome, rheumatic fever, Glucocorticoids, Cardiovascular System, autoimmune diseases, immune-modulation, cardioprotection, idiopathic heart diseases, myocarditis, dilated cardiomyopathy, sarcoidosis, pericardial diseases, endocarditis, cardiac amyloidosis, cardiopulmon, dyslipidemia, diabetes, cytosolic glucorticoid receptor, interferon regulator factor 3, membrane-bound GC receptor, cyclooxygenase, CD95 expression, macrophages, T-lymphocytes, tumor suppressors, cytokines, annexins, ischemia, NF-B, Endogenous peroxynitrite, myocardium, vascular cell adhesion molecule, granulocyte, –, macrophage colony-stimulating factor, calpain 6, caspase 11, S6 kinase, Acute Myocardial Infarction, beclomethasone, Angina, Tuberculosis, NSAIDs, pericarditis, Staphylococcus aureus, troponin I, dexamethasone, Atrio-Ventricular Conduction Abnormalities, pregnancy, Pulse Therapy