From the Guidelines
Corticosteroids can exacerbate congestive heart failure (CHF) due to their potential to cause fluid retention, hypertension, and electrolyte imbalances, among other effects. According to the European Society of Cardiology guidelines 1, corticosteroids are listed as drugs to avoid or beware of when co-prescribed with any form of heart failure treatment. The guidelines emphasize the importance of using caution when prescribing these medications to patients with heart failure.
Some of the key ways steroids can worsen heart failure include:
- Fluid retention, leading to increased blood volume and additional strain on the heart
- Sodium retention and potassium excretion, which can exacerbate hypertension and contribute to edema
- Increased blood glucose levels, potentially worsening or precipitating diabetes and creating additional cardiovascular risk
- Accelerated atherosclerosis and dyslipidemia with long-term use, further compromising cardiac function
If corticosteroids are necessary for treating another condition in a heart failure patient, the lowest effective dose should be used for the shortest possible duration, with careful monitoring of weight, blood pressure, electrolytes, and symptoms of worsening heart failure. This approach is crucial to minimize cardiac complications, and collaboration between the patient's cardiologist and the prescribing physician is essential. Additionally, diuretics may need adjustment during steroid therapy to counteract fluid retention, and alternative non-steroid treatments should be considered whenever possible for patients with significant heart failure 1.
From the FDA Drug Label
Cardio-Renal As sodium retention with resultant edema and potassium loss may occur in patients receiving corticosteroids, these agents should be used with caution in patients with congestive heart failure, hypertension, or renal insufficiency.
In addition, there have been cases reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure
- Corticosteroids can exacerbate congestive heart failure (CHF) due to sodium retention, edema, and potassium loss.
- The use of corticosteroids in patients with CHF should be done with caution.
- There is a reported association between the concomitant use of certain medications (e.g., amphotericin B) and corticosteroids, which may lead to cardiac enlargement and congestive heart failure 2, 2.
From the Research
Corticosteroids and Congestive Heart Failure
- The relationship between corticosteroids and congestive heart failure (CHF) is complex, with some studies suggesting that corticosteroids may exacerbate CHF, while others indicate potential benefits in certain contexts 3, 4, 5, 6.
- A study published in the European journal of heart failure found that burst steroid therapy was associated with reduced inflammation and improved quality of life in patients with acute heart failure (AHF) 3.
- Another study published in the European journal of clinical investigation identified steroid-based signatures of inflammation, coronary microvascular dysfunction, and left ventricular hypertrophy that were associated with subsequent heart failure events in patients with ischemic heart disease 4.
- A post hoc analysis of the CORTAHF randomized, open-label, pilot trial found that 7-day steroid therapy was associated with reduction in signs of congestion up to day 31 in patients with AHF and inflammatory activation 5.
- However, a study published in ESC heart failure found that the effect of systemic corticosteroid therapy on clinical outcomes in patients with AHF was modified by the degree of inflammation, with potential benefits in patients with high C-reactive protein levels 6.
- The American Heart Association has published a scientific statement on drugs that may cause or exacerbate heart failure, which includes corticosteroids as a potential culprit 7.
Key Findings
- Corticosteroids may have both positive and negative effects on CHF, depending on the context and patient population.
- Inflammatory activation may play a key role in determining the response to corticosteroid therapy in patients with CHF.
- Further research is needed to fully understand the relationship between corticosteroids and CHF, and to identify potential benefits and risks in different patient populations 3, 4, 5, 6.