Abstract 245: Cause specific Cardiovascular Risk Associated with use of Non Steroidal Anti-Inflammatory Drugs among Patients with Prior Myocardial Infarction - a Nationwide Cohort Study.

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Anne-Marie Schjerning Olsen ◽  
Emil L Fosbøl ◽  
Jesper Lindhardsen ◽  
Charlotte Andersson ◽  
Fredrik Folke ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Risk ◽  
Confidence Interval ◽  
Cardiovascular Death ◽  
Nonfatal Stroke ◽  
Prior Myocardial Infarction ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Background: Non steroidal anti-inflammatory drugs(NSAIDs) utilization has been associated with worsened outcomes among patients with established cardiovascular disease.We analyzed the cause-specific cardiovascular risk associated with use of NSAIDs in a nationwide cohort of patients with prior myocardial infarction (MI). Methods: By individual-level linkage of nationwide registries of hospitalizations and drug dispenses from pharmacies in Denmark, patients aged >30 years admitted with first-time MI during 1997-2009 and their subsequent NSAID use were identified. The risk of cardiovascular death, a composite of coronary death or nonfatal MI, and fatal or nonfatal stroke with NSAID use was analyzed by adjusted Cox proportional hazard models. Results: Of 97,698 patients included (mean age 69 years (SD 13.0), 63.0% men),44.0% received NSAIDs during follow-up. Relative to no NSAID use, overall NSAID was associated with an increased risk of cardiovascular death (hazard ratio [HR] 1.52 95% confidence interval [CI] 1.34-1.73). In particular, use of the nonselective NSAID diclofenac and the selective cyclooxygenase-2 (COX-2) inhibitor rofecoxib was associated with increased risk of cardiovascular death (HR 2.05 95% confidence interval CI 1.88-2.23) and HR 1.74(CI.1.53-1.98), respectively) with a dose dependent increase in risk. Use of ibuprofen was associated with increased risk of fatal/nonfatal stroke (HR 1.27(CI. 1.14-1.41)).Naproxen was associated with the lowest risk of all outcomes, although higher than no NSAID use. Conclusion: The cause specific cardiovascular risks associated with the use of individual NSAIDs found to differ and in particular rofecoxib and diclofenac were associated with increased cardiovascular morbidity and mortality. These results further support caution in use of NSAIDs in patients with prior MI.

scholarly journals Rheumatoid arthritis: influence of inflammation and anti-inflammatory therapy on cardiovascular risk factors

2020 ◽  
pp. 32-44
Author(s):  
D. I. Trukhan ◽  
D. S. Ivanova ◽  
K. D. Belus
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
Cardiovascular Risk Factors ◽  
Chronic Inflammation ◽  
Pharmacological Intervention ◽  
Increased Risk ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Rheumatoid arthritis is a frequent and one of the most severe immuno-inflammatory diseases in humans, which determines the great medical and socio-economic importance of this pathology. One of the priority problems of modern cardiac rheumatology is an increased risk of cardiovascular complications in rheumatoid arthritis. In patients with rheumatoid arthritis, traditional cardiovascular risk factors for cardiovascular diseases (metabolic syndrome, obesity, dyslipidemia, arterial hypertension, insulin resistance, diabetes mellitus, smoking and hypodynamia) and a genetic predisposition are expressed. Their specific features also have a certain effect: the “lipid paradox” and the “obesity paradox”. However, chronic inflammation as a key factor in the development of progression of atherosclerosis and endothelial dysfunction plays a leading role in morbidity and mortality from cardiovascular diseases in rheumatoid arthritis. This review discusses the effect of chronic inflammation and its mediators on traditional cardiovascular risk factors and its independent significance in the development of CVD. Drug therapy (non-steroidal anti-inflammatory drugs, glucocorticosteroids, basic anti-inflammatory drugs, genetically engineered biological drugs) of the underlying disease also has a definite effect on cardiovascular risk factors in patients with rheumatoid arthritis. A review of studies on this problem suggests a positive effect of pharmacological intervention in rheumatoid arthritis on cardiovascular risk factors, their reduction to a level comparable to the populations of patients not suffering from rheumatoid arthritis. The interaction of rheumatologists, cardiologists and first-contact doctors (therapist and general practitioner) in studying the mechanisms of the development of atherosclerosis in patients with rheumatoid arthritis will allow in real clinical practice to develop adequate methods for the timely diagnosis and prevention of cardiovascular diseases in patients with rheumatoid arthritis.

scholarly journals Cause-Specific Cardiovascular Risk Associated with Nonsteroidal Anti-Inflammatory Drugs among Myocardial Infarction Patients - A Nationwide Study

PLoS ONE ◽  
2013 ◽  
Vol 8 (1) ◽  
pp. e54309 ◽  
Author(s):  
Anne-Marie Schjerning Olsen ◽  
Emil L. Fosbøl ◽  
Jesper Lindhardsen ◽  
Charlotte Andersson ◽  
Fredrik Folke ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Risk ◽  
Nationwide Study ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Abstract W P170: Effect of “Snoring Alone” and “Snoring Plus Phenomenon” on Cardiovascular Diseases, or Fatal, or Nonfatalstroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Yousef M Mohammad ◽  
Ahmed A Malik ◽  
Omar Saeed ◽  
M. Fared K Suri ◽  
Adnan I Qureshi
Keyword(s):  
Myocardial Infarction ◽  
Observational Study ◽  
Proportional Hazards ◽  
Cardiovascular Death ◽  
Cox Proportional Hazards ◽  
Nonfatal Myocardial Infarction ◽  
Nonfatal Stroke ◽  
Increased Risk ◽  
Cardiovascular Endpoint

Background: We evaluated the effect of snoring and snoring with unique habitual sleep patterns on cardiovascular events. Methods: We analyzed the data from Women's Health Initiative (WHI) observational study. The participants in the observational study were 93,676 women aged 50-79 years who were recruited from September 1994 to December 1998, with annual follow-up through August 14, 2009 (an average of 8 years). Cox proportional hazards analysis was used to examine the effect of snoring alone and snoring with sleep duration >8 hours and/or frequent daytime napping (snoring plus phenomenon) and the outcome of total cardiovascular disease defined as cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke after adjusting for potential confounders. Results: Of the 93676 participants, 25777 reported snoring alone and 329 reported snoring plus phenomenon. The cumulative endpoint of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke was seen in 1140 of 25777 (p<.0001) and 24 of 329 (p<.0001) participants with snoring alone and snoring plus phenomenon compared with 3316 of 61396 non snoring participants. Compared with non-snoring participants, snoring plus phenomenon was not associated with an increased risk of cardiovascular endpoint (relative risk [RR] 1.1, 95% confidence interval [CI] 0.8 -1.4, p=0.6), after adjusting for age/gender, hypertension, diabetes mellitus, cigarette smoking, and hyperlipidemia. Snoring alone was not associated with risk of cardiovascular endpoint (RR 0.9, 95% CI 0.5 -1.5, p=0.6). The risk of non-fatal and fatal stroke was higher among participants with snoring plus phenomenon (RR 1.7, 95% CI 1.0 -3.0, p=0.047) but not snoring alone (RR 0.8 95% CI 0.6 -1.0, p=0.07) after adjusting for potential confounders. Conclusions: Persons with snoring plus phenomenon (but not snoring alone) are at risk of cardiovascular endpoints of nonfatal and fatal strokes.

scholarly journals The efficacy and safety of dual-pathway inhibition therapy among patients with peripheral arterial disease – a meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Mapili ◽  
A S Davin ◽  
L M Villanueva
Keyword(s):  
Myocardial Infarction ◽  
Antiplatelet Therapy ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Acute Limb Ischemia ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
Dual Pathway ◽  
Pathway Inhibition

Abstract Background and objectives Peripheral artery disease (PAD) affects more than 200 million people worldwide and it is associated with an increased risk for cardiovascular morbidity and mortality. Current recommendations regarding the management of PAD have been controversial. Our meta-analysis investigated the efficacy of direct Xa inhibitor plus antiplatelet, also known as dual-pathway inhibition (DPI), on the individual components of major adverse cardiovascular events (stroke, myocardial infarction, and cardiovascular death) and major adverse limb events (amputation, restenosis, revascularization, and acute limb ischemia), the composite of MACE and MALE and its safety, in terms of bleeding, compared to antiplatelet therapy among patients with PAD. Methodology We performed a random-effects meta-analysis among patients with PAD comparing DPI to antiplatelet therapy. PubMed, EMBASE, CENTRAL, and ClinicalTrials.gov were searched from their dates of inception to August 2020 for Randomized Controlled Trials. Three studies met the inclusion criteria for final analysis. The selected studies were assessed for risk of bias using the Cochrane RoB2 tool and the overall quality of evidence was assessed using the GRADE approach. Results Among patients with PAD, DPI significantly reduces the risk of adverse limb events excluding amputation (RR 0.69, 95% CI 0.57–0.83) and composite MACE and MALE (RR 0.80, 95% CI 0.69–0.93) but significantly increases risk of major bleeding (RR 1.43, 95% CI 1.06–1.93) compared to antiplatelet therapy alone. Overall, DPI did not reduce myocardial infarction, stroke, cardiovascular death, or amputation, or increase the risk of fatal bleeding. Conclusions Among patients with PAD, DPI is more effective than antiplatelet therapy alone in preventing adverse limb events excluding amputation with an increased risk of major bleeding. We recommend the use of DPI among patients with PAD who are at a low risk of bleeding. FUNDunding Acknowledgement Type of funding sources: None.

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