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In general it has been found that oral steroids are more likely to prove detrimental to cardiovascular health than injectable forms of non C-17 alkyl steroids. In this regard it is important to point out that estrogen is actually known to have a positive effect on cholesterol levels, enhancing HDL levels, and keeping LDL levels under control. It is when aromatase inhibitors in ancillary compounds come into play during the steroid cycles that the individual is at risk of cardio-vascular diseases owing to estrogen levels being subdued. Further, it has been seen that when the individual is committed to a healthy diet that supports desired cholesterol levels during the steroid cycle , the risk of cardiovascular disease arising from steroid use can be kept under control.

Narrative: Chronic obstructive pulmonary disease (COPD), a term that encompasses both patients diagnosed with chronic bronchitis and emphysema, is an obstructive lung disease in many cases caused by years of tobacco smoking. It is thought that patients with COPD ‘exacerbation’ (increased shortness of breath or change in their chronic cough and sputum) may benefit from steroids, presumably by reducing the inflammatory response that accompanies the exacerbation.

Benefits: 10 studies contributed data for this Cochrane analysis, representing 1051 patients. There was no statistically significant difference in the mortality of subjects who received systemic steroids compared to placebo. In regards to treatment failure, the review found a NNT of 10 (% reduction). Interestingly, no benefit was found in analysis of studies with steroids for less than 72 hours. The reductions in treatment failure were recorded from studies including both admitted and outpatient/Emergency Department patients.

Harms: Corticosteroids can cause multiple side effects, and some studies evaluated harms, though this was inconsistent across studies. When harms were pooled, there was an absolute risk increase of % for patients receiving steroids (NNH = 7) though this includes some harms that are not patient-oriented (high blood sugars) as well as some that are patient-oriented (diarrhea).

The early steps in the biosynthesis of steroids of both plants and animals are the same, except that in plants lanosterol is replaced by the related compound cycloartenol, which contains a three-membered ring (C9, C10, C19) in lieu of the nuclear double bond of lanosterol. The side chains of the phytosterols, such as stigmasterol, and of the sterol ergosterol of yeasts and other fungi contain extra carbon atoms that are incorporated in reactions involving S -adenosylmethionine, which donates methyl groups in numerous biological processes. Although most plant tissues contain only traces of cholesterol, this sterol is the biogenetic precursor of such important plant steroids as the sapogenins , glycosides , and alkaloids . Because pregnane derivatives are intermediates in some of these transformations, plants and animals appear to have important features of steroid metabolism in common.

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