From the Guidelines
Prednisone can increase LDL cholesterol levels, particularly at high doses or with prolonged treatment, as evidenced by its proatherosclerotic actions, including alterations of lipoprotein levels and cell cholesterol handling 1. The use of prednisone, a glucocorticoid, in the treatment of various conditions, including rheumatoid arthritis, has been associated with changes in lipid profiles, which can be a concern for cardiovascular risk management. According to a 2020 position paper by the European Society of Cardiology, the proatherosclerotic actions of glucocorticoids, such as prednisone, can be partly counteracted by their anti-inflammatory properties, but high-dose treatment (daily doses >7.5 mg or cumulative doses > 40 g prednisone or its equivalent) has been linked to increased cardiovascular risk 1. Some key points to consider include:
- The impact of prednisone on LDL levels can be significant, especially with higher doses and longer treatment durations.
- Lipid monitoring should be adjusted to the overall situation, taking into account the individual's risk factors and life expectancy.
- Employing alternative treatments, such as hydroxychloroquine, which has been reported to improve lipid profiles, may help mitigate the cardiovascular risks associated with prednisone use 1.
- Patients on long-term prednisone therapy should be closely monitored for changes in their lipid profiles and may require dietary changes, exercise, or cholesterol-lowering medications to manage their cardiovascular risk.
From the Research
Effect of Prednisone on LDL Levels
- The study 2 found that prednisone did not change the levels of low-density lipoprotein (LDL) in healthy men.
- Another study 3 also found that mean plasma LDL-C did not show a significant change after short-term, low-dose corticosteroid treatment.
- However, the same study 3 found a strong relationship between change in plasma total cholesterol and change in LDL-C, suggesting that an increase in total cholesterol may be indicative of a change in LDL-C.
- A study 4 found that prednisone increased very low density lipoprotein (VLDL) but did not specifically mention an increase in LDL.
- A more recent study 5 found no significant difference in LDL levels between patients taking prednisolone and those taking hydrocortisone, suggesting that prednisolone may not have a significant impact on LDL levels.
Overall Impact of Prednisone on Lipid Profiles
- Prednisone has been shown to increase high-density lipoprotein (HDL) cholesterol levels in several studies 2, 3, 4.
- The effect of prednisone on LDL levels is less clear, with some studies finding no significant change 2, 3 and others suggesting a possible increase 3.
- Overall, the impact of prednisone on lipid profiles appears to be complex and may depend on various factors, including the dose and duration of treatment.