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A Population-Based, Case-Control Study

Christian Fynbo Christiansen, MD; Steffen Christensen, MD; Frank Mehnert, MSc; Steven R. Cummings, MD; Roland D. Chapurlat, MD, PhD; Henrik Toft Sørensen, MD, PhD, DMSc

Arch Intern Med. 2009;169(18):1677-1683.

Background  Glucocorticoid use is associated with increased risk of myocardial infarction, stroke, and heart failure, but data are limited on the risk of atrial fibrillation or flutter. We examined whether glucocorticoid use is associated with the risk of atrial fibrillation or flutter.

Methods  For this population-based, case-control study, we identified all patients with a first hospital diagnosis of atrial fibrillation or flutter from January 1, 1999, through December 31, 2005, in Northern Denmark (population, 1.7 million). For each case we selected 10 population controls matched by age and sex. We obtained data on glucocorticoid prescriptions within 60 days (current users) or longer before the index date (former users), comorbidity, and medications from medical databases. We used conditional logistic regression to compute odds ratios (ORs), controlling for potential confounders.

Results  Among 20 221 patients with atrial fibrillation or flutter, 1288 (6.4%) were current glucocorticoid users and 2375 (11.7%) were former users. Among 202 130 population controls, 5245 (2.6%) were current glucocorticoid users and 19 940 (9.9%) were former users. Current glucocorticoid use was associated with an increased risk of atrial fibrillation or flutter compared with never use (adjusted OR, 1.92; 95% confidence interval [CI], 1.79-2.06). Among new glucocorticoid users, the adjusted OR was 3.62 (95% CI, 3.11-4.22) and among long-term users it was 1.66 (95% CI, 1.53-1.80). The increased risk remained robust in patients with and without pulmonary and cardiovascular diseases. Former glucocorticoid use was not associated with increased risk (adjusted OR, 1.00; 95% CI, 0.96-1.06).

Conclusion  Current glucocorticoid use was associated with an almost 2-fold increased risk of atrial fibrillation or flutter.

Author Affiliations: Departments of Clinical Epidemiology (Drs Christiansen, Christensen, and Sørensen and Mr Mehnert) and Anesthesiology and Intensive Care Medicine (Dr Christiansen), Aarhus University Hospital, Aarhus, Denmark; San Francisco Coordinating Center, California (Dr Cummings); and Institut National de la Santé et la Recherche Médicale Research Unit 831, Université de Lyon, and Department of Orthopedics and Rheumatology, Hôpital Edouard Herriot, Lyon, France (Dr Chapurlat).

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