Cardiovascular risks associated with use of non-steroidal anti-inflammatory drugs in patients with non-obstructive coronary artery disease

Abstract Aim To examine whether non-aspirin non-steroidal anti-inflammatory drugs (NSAID) use is associated with increased cardiovascular risks in patients with non-obstructive coronary artery disease (CAD). Methods and results Using Danish medical registries, we conducted a population-based cohort study in Western Denmark during 2008–2017. We identified all patients undergoing first-time coronary computed tomography angiography (CCTA) due to suspected CAD (n = 35,399), with results showing no (n = 28,581) or non-obstructive CAD (n = 6,818). Multivariate Cox regression was used to compute hazard ratios of major adverse cardiac events (MACE) including incident myocardial infarction, coronary intervention, or death. The rate of MACE increased by 33% for any NSAID use compared with non-use (hazard ratio 1.33, 95% confidence interval (CI) 1.06 to 1.68) in patients with no CAD and by 48% (1.48, 95% CI 1.06 to 2.07) in patients with non-obstructive CAD. Rate difference of MACE, per 100 person-years, was 0.38 (95% CI 0.08 to 0.67) in patients with no CAD (number needed to harm 267) and 1.08 (95% CI 0.06 to 2.11) in patients with non-obstructive CAD (number needed to harm 92). Current use of older COX-2 inhibitors was associated with the highest hazard ratio in patients with non-obstructive CAD, both when ascertained as pre-CCTA use (2.9-fold increase) and from time-varying use (1.8-fold increase). Conclusion NSAID use in patients with CCTA-confirmed no and non-obstructive CAD was associated with an increased cardiovascular risk compared with non-use. The absolute risk differences and numbers needed to harm were considered clinically relevant, particularly in patients with non-obstructive CAD.

Download Full-text

Role of Vascular Inflammation in Coronary Artery Disease: Potential of Anti-inflammatory Drugs in the Prevention of Atherothrombosis

American Journal of Cardiovascular Drugs ◽

10.1007/s40256-014-0094-z ◽

2014 ◽

Vol 15 (1) ◽

pp. 1-11 ◽

Cited By ~ 47

Author(s):

Daniel Medeiros Moreira ◽

Roberto Leo da Silva ◽

Jefferson Luís Vieira ◽

Tammuz Fattah ◽

Maria Emilia Lueneberg ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Vascular Inflammation ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Artery Disease

Download Full-text

Prognostic Implication of Non-Obstructive Coronary Lesions: A New Classification in Different Settings

Journal of Clinical Medicine ◽

10.3390/jcm10091863 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1863

Author(s):

Jorge Rodríguez-Capitán ◽

Andrés Sánchez-Pérez ◽

Sara Ballesteros-Pradas ◽

Mercedes Millán-Gómez ◽

Rosa Cardenal-Piris ◽

...

Keyword(s):

Coronary Artery Disease ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Confidence Interval ◽

Obstructive Coronary Artery Disease ◽

Hazard Ratio ◽

Coronary Syndrome ◽

Cardiovascular Prognosis ◽

Artery Disease

The clinical significance of non-obstructive coronary artery disease is the subject of debate. Our objective was to evaluate the long-term cardiovascular prognosis associated with non-obstructive coronary artery disease in patients undergoing coronary angiography, and to conduct a stratification by sex, diabetes, and clinical indication. We designed a multi-centre retrospective longitudinal observational study of 3265 patients that were classified into three groups: normal coronary arteries (lesion <20%, 1426 patients), non-obstructive coronary artery disease (20–50%, 643 patients), and obstructive coronary artery disease (>70%, 1196 patients). During a mean follow-up of 43 months, we evaluated a combined cardiovascular event: acute myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death. Multivariable-adjusted Cox proportional hazard models showed a worse prognosis in patients with non-obstructive coronary artery disease, in comparison with patients of normal coronary arteries group, in the total population (hazard ratio 1.72, 95% confidence interval 1.23–2.39; p for trend <0.001), in non-diabetics (hazard ratio 2.12, 95% confidence interval: 1.40–3.22), in women (hazard ratio 1.75, 95% confidence interval 1.10–2.77), and after acute coronary syndrome (hazard ratio 2.07, 95% confidence interval 1.25–3.44). In conclusion, non-obstructive coronary artery disease is associated with an impaired long-term cardiovascular prognosis. This association held for non-diabetics, women, and after acute coronary syndrome.

Download Full-text

Association between anti-diabetes treatments and cardiovascular risk in diabetes patients with and without coronary artery disease

Diabetes and Vascular Disease Research ◽

10.1177/1479164119836227 ◽

2019 ◽

Vol 16 (4) ◽

pp. 351-359 ◽

Cited By ~ 4

Author(s):

Christine Gyldenkerne ◽

Kevin Kris Warnakula Olesen ◽

Morten Madsen ◽

Troels Thim ◽

Lisette Okkels Jensen ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Confidence Interval ◽

Obstructive Coronary Artery Disease ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Artery Disease ◽

Glucose Lowering Therapy ◽

Diabetes Patients

Objective: We examined the risk of myocardial infarction associated with glucose-lowering therapy among diabetes patients with and without obstructive coronary artery disease. Methods: A cohort of patients with type 1 or type 2 diabetes (n = 12,030), who underwent coronary angiography from 2004 to 2012, were stratified by presence of obstructive (any stenosis ⩾50%) coronary artery disease and by type of diabetes treatment: diet, non-insulin treatment and insulin (±oral anti-diabetics). The primary endpoint was myocardial infarction. Adjusted hazard ratios were calculated using diet-treated patients without coronary artery disease as reference. Results: In patients without coronary artery disease, risk of myocardial infarction was similar in patients treated with non-insulin medication (adjusted hazard ratio 0.70, 95% confidence interval 0.27–1.81) and insulin (adjusted hazard ratio 0.76, 95% confidence interval 0.27–2.08) as compared to diet only. In patients with coronary artery disease, the risk of myocardial infarction was higher than in the reference group and an incremental risk was observed being lowest in patients treated with diet (adjusted hazard ratio 3.79, 95% confidence interval 1.61–8.88), followed by non-insulin medication (adjusted hazard ratio 5.42, 95% confidence interval 2.40–12.22), and highest in insulin-treated patients (adjusted hazard ratio 7.91, 95% confidence interval 3.51–17.82). Conclusion: The presence of obstructive coronary artery disease defines the risk of myocardial infarction in diabetes patients. Glucose-lowering therapy, in particular insulin, was associated with risk of myocardial infarction only in the presence of coronary artery disease.

Download Full-text

Effective Ibuprofen Desensitization in a Patient with Myopericarditis

Pharmacology ◽

10.1159/000495692 ◽

2018 ◽

Vol 103 (3-4) ◽

pp. 111-113 ◽

Cited By ~ 1

Author(s):

Gabriele Cortellini ◽

Domenico Lippolis ◽

Silvia Amati ◽

Giancarlo Piovaccari ◽

Fabio Cortellini ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Respiratory Diseases ◽

The Other ◽

Aspirin Desensitization ◽

Other Hand ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Artery Disease ◽

Few Data

To date, aspirin desensitization is employed with patients with nonsteroidal anti-inﬂammatory drugs (NSAIDs) exacerbated respiratory diseases (NERD) or with aspirin or NSAIDs hypersensitive patients needing a stent procedure for coronary artery disease. On the other hand, few data exist regarding aspirin desensitization in other cardiological features and particularly we haven’t data on different NSAIDs desensitization. Only for NERD patients we have data on ketorolac use. We report an efficacious desensitization procedure for ibuprofen in urticaria/angioedema patient with pericarditis and myocarditis associated.

Download Full-text

Faculty Opinions recommendation of Evaluation of the predictive value of coronary artery calcium score for obstructive coronary artery disease in asymptomatic Korean patients with type 2 diabetes mellitus.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725087687.793510525 ◽

2015 ◽

Author(s):

Nathan Wong

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Type 2 Diabetes Mellitus ◽

Coronary Artery ◽

Coronary Artery Calcium Score ◽

Obstructive Coronary Artery Disease ◽

Calcium Score ◽

Artery Disease

Download Full-text

Gender Differences in Non-Obstructive Coronary Artery Disease

Current Pharmaceutical Design ◽

10.2174/1381612826666201012163845 ◽

2020 ◽

Vol 26 ◽

Author(s):

Maria Bergami ◽

Marialuisa Scarpone ◽

Edina Cenko ◽

Elisa Varotti ◽

Peter Louis Amaduzzi ◽

...

Keyword(s):

Coronary Artery Disease ◽

Gender Differences ◽

Heart Disease ◽

Coronary Artery ◽

Ischemic Heart Disease ◽

Coronary Arteries ◽

Obstructive Coronary Artery Disease ◽

Ischemic Heart ◽

Current Evidence ◽

Artery Disease

: Subjects affected by ischemic heart disease with non-obstructive coronary arteries constitute a population that has received increasing attention over the past two decades. Since the first studies with coronary angiography, female patients have been reported to have non-obstructive coronary artery disease more frequently than their male counterparts, both in stable and acute clinical settings. Although traditionally considered a relatively infrequent and low-risk form of myocardial ischemia, its impact on clinical practice is undeniable, especially when it comes to infarction, where the prognosis is not as benign as previously assumed. Unfortunately, despite increasing awareness, there are still several questions left unanswered regarding diagnosis, risk stratification and treatment. The purpose of this review is to provide a state of the art and an update on current evidence available on gender differences in clinical characteristics, management and prognosis of ischemic heart disease with non-obstructive coronary arteries, both in the acute and stable clinical setting.

Download Full-text

OCT Findings in MINOCA

Journal of Clinical Medicine ◽

10.3390/jcm10132759 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2759

Author(s):

Krzysztof Bryniarski ◽

Pawel Gasior ◽

Jacek Legutko ◽

Dawid Makowicz ◽

Anna Kedziora ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Imaging Modality ◽

Obstructive Coronary Artery Disease ◽

Coronary Artery Spasm ◽

Morphological Characteristics ◽

Artery Dissection ◽

Plaque Disruption ◽

Artery Disease

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is a working diagnosis for patients presenting with acute myocardial infarction without obstructive coronary artery disease on coronary angiography. It is a heterogenous entity with a number of possible etiologies that can be determined through the use of appropriate diagnostic algorithms. Common causes of a MINOCA may include plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, and coronary thromboembolism. Optical coherence tomography (OCT) is an intravascular imaging modality which allows the differentiation of coronary tissue morphological characteristics including the identification of thin cap fibroatheroma and the differentiation between plaque rupture or erosion, due to its high resolution. In this narrative review we will discuss the role of OCT in patients presenting with MINOCA. In this group of patients OCT has been shown to reveal abnormal findings in almost half of the cases. Moreover, combining OCT with cardiac magnetic resonance (CMR) was shown to allow the identification of most of the underlying mechanisms of MINOCA. Hence, it is recommended that both OCT and CMR can be used in patients with a working diagnosis of MINOCA. Well-designed prospective studies are needed in order to gain a better understanding of this condition and to provide optimal management while reducing morbidity and mortality in that subset patients.

Download Full-text