Anthropometrics and metabolic syndrome in relation to glucocorticoid receptor polymorphisms in corticosteroid users

INTRODUCTION Corticosteroids are widely prescribed and their use has been linked to adverse cardiometabolic outcomes. A pivotal role in the action of corticosteroids is reserved for the glucocorticoid receptor (GR). Here, we assessed the relationship of glucocorticoid (GC) sensitivity altering GR polymorphisms with anthropometrics and metabolic syndrome (MetS) in corticosteroid users. METHODS In this population-based cohort study (Lifelines) we genotyped 10,621 adult participants for GR hypersensitive (1/2 copies BclI and/or N363S) and GR resistant (1/2 copies ER22/23EK and/or 9β) variants. We assessed the relationship between functional GR polymorphisms with body mass index (BMI), waist circumference (WC), and MetS in users of corticosteroids. RESULTS Overall corticosteroid use was associated with a significantly higher BMI and WC in GR wild-type users (BMI: +0.63 kg/m2 [0.09-1.16], P=.022; WC: +2.03 cm [0.61-3.44], P=.005) and GR hypersensitive (BMI: mean difference +0.66 kg/m2 [95% CI, 0.31-1.01); WC: +2.06 cm (1.13-2.98), both P<.001), but not in GR resistant users. Significantly higher WC in GR resistant carriers was observed only for inhaled corticosteroid users. With respect to MetS, again only GR wild-type users (OR 1.44 [1.07-1.94], P=.017) and GR hypersensitives (odds ratio (OR) 1.23 [95% CI, 1.00-1.50], P=.046) were more likely to have MetS; even more pronounced in only inhaled corticosteroid users (GR wild-type users, OR 1.64 [1.06-2.55], P=.027; GR hypersensitive users, OR 1.43 [1.08-1.91], P=.013). CONCLUSIONS Polymorphisms associated with increased GR sensitivity and wild-type GR are related to increased BMI, WC and an increased MetS presence in corticosteroid users, especially of the inhaled types, when compared to nonusers. The adverse effects of corticosteroid use are less pronounced in users harboring GR resistant polymorphisms.