Original ArticleSystemic Glucocorticoids Are Associated With Mortality After Carotid EndarterectomySiemelink, Marten MD*; den Ruijter, Hester PhD*; van der Valk, Fleur MD†; de Vries, Jean-Paul PhD‡; de Borst, Gert Jan PhD§; Moll, Frans PhD§; Stroes, Erik PhD†; Pasterkamp, Gerard MD, PhD*,¶Author Information *Utrecht University Medical Center, Laboratory of Experimental Cardiology, Utrecht, the Netherlands; †Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands; ‡Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands; §Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; and ¶Reseach Laboratory Clinical Chemistry, University Medical Center Utrecht, Utrecht, the Netherlands. Reprints: Gerard Pasterkamp, MD, PhD, Utrecht University Medical Center, Laboratory of Experimental Cardiology, Heidelberglaan 100 rm G02.523, 3584CX Utrecht, the Netherlands (e-mail: [email protected]). M. Siemelink acknowledges funding by the European Union (BiomarCaRE, grant number: HEALTH-2011-278913) and Technology Foundation STW (Stichting voor de Technische Wetenschappen—Danone partnership program, Project 11679). The authors report no conflicts of interest. Received January 16, 2015 Accepted June 22, 2015 Journal of Cardiovascular Pharmacology: October 2015 - Volume 66 - Issue 4 - p 392-398 doi: 10.1097/FJC.0000000000000292 Buy Metrics Abstract Glucocorticoids (GCs) are widely used anti-inflammatory drugs well known to cause many adverse effects. Still, there is a dearth of data on the long-term cardiovascular effects of GCs in patients with established cardiovascular disease and the effect on atherosclerotic plaque composition. A total of 1894 patients who underwent carotid endarterectomy (CEA), of whom 40 patients received systemic GCs, were included in the Athero-Express Biobank. Atherosclerotic plaque samples and peripheral blood samples were obtained during CEA. Cardiovascular events during 3 years of follow-up were investigated using Cox regression modeling to adjust for possible confounding. Atherosclerotic plaque composition was examined using immunohistochemical staining. Use of GCs at inclusion was associated with markedly increased incidences of ischemic stroke (15.2% vs. 5.9%), composite events (48.5% vs. 26.9%), and cardiovascular death (21.2% vs. 5.7%), as well as an increased risk of cardiovascular death (hazards ratio 2.7, 95% confidence interval, 1.1–6.7) and all-cause death (hazards ratio 2.3, 95% confidence interval, 1.1–4.8) after 2.6 years of follow-up. None of the histological features of atherosclerotic plaques were significantly different in patients using GCs. After CEA, the use of systemic GCs is independently associated with an increased incidence of cardiovascular events and an increased risk of cardiovascular and all-cause death, but not atherosclerotic plaque composition. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.