Azithromycin and the Risk of Cardiovascular Complications

2013 ◽  
Vol 27 (5) ◽  
pp. 496-500 ◽  
Author(s):  
Nicole M. Maisch ◽  
Jenny G. Kochupurackal ◽  
Jonathan Sin
Keyword(s):  
Cohort Study ◽  
Case Reports ◽  
Torsades De Pointes ◽  
Cardiac Risk ◽  
Cardiovascular Death ◽  
Cardiovascular Complications ◽  
Qt Prolongation ◽  
Baseline Risk ◽  
Cardiac Events ◽  
Increased Risk

The purpose of this review was to evaluate the literature to assess the incidence and true clinical relevance of recent Food and Drug Administration warnings regarding QT prolongation with azithromycin, given its widespread use, with over 40 million US outpatient prescriptions written in 2011. A literature search of MEDLINE (1946 to May 2013) and International Pharmaceutical Abstracts (1970 to May 2013) was conducted using the terms azithromycin, QT prolongation, torsades de pointes, arrhythmia, and cardiovascular death. A bibliographic search was also performed. Several relevant studies and case reports were identified and reviewed. One cohort study revealed an increased risk of cardiovascular death with azithromycin compared to no antibiotic, especially in those with higher cardiovascular risk. Another cohort study comparing azithromycin, penicillin V, and no antibiotic in a younger Danish population with less cardiac risk found no increased cardiovascular death associated with azithromycin use. The majority of case reports involved ill and/or elderly patients with multiple comorbidities and concomitant medications who were already at a higher risk of cardiovascular events. Although there is evidence that azithromycin may induce QT prolongation and adverse cardiac events, the incidence is fairly limited to patients with high baseline risk, including those with preexisting cardiovascular conditions and concomitant use of other QT-prolonging drugs.

Cardiovascular complications of novel multiple myeloma treatments

ESC CardioMed ◽  
2018 ◽  
pp. 1176-1178
Author(s):  
Daniel J. Lenihan
Keyword(s):  
Heart Failure ◽  
Multiple Myeloma ◽  
Heart Disease ◽  
Early Detection ◽  
Antithrombotic Therapy ◽  
Cardiovascular Events ◽  
Cardiovascular Complications ◽  
Novel Therapies ◽  
Cardiac Events ◽  
Increased Risk

The treatment of multiple myeloma has dramatically changed in the last decade. Novel therapies have had an important impact on the overall outcome for patients but are associated with important cardiovascular events. There is certainly concern about the development of heart failure but also treatment-induced hypertension and a known increased risk of thrombotic events, including ischaemic heart disease. The management of these cardiac events includes prevention, early detection, and optimal treatment with antithrombotic therapy as well as medical therapy for heart failure.

scholarly journals Empagliflozin reduced long-term HbA1c variability and cardiovascular death: insights from the EMPA-REG OUTCOME trial

2020 ◽  
Author(s):  
Antonio Ceriello ◽  
Anne Pernille Ofstad ◽  
Isabella Zwiener ◽  
Stefan Kaspers ◽  
Jyothis George ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Standard Deviation ◽  
Cox Regression ◽  
Glucose Variability ◽  
Cardiovascular Death ◽  
Baseline Risk ◽  
Increased Risk ◽  
Outcome Trial ◽  
Hba1c Variability

Abstract Background: Glucose variability has been associated with cardiovascular outcomes in type 2 diabetes, however, the interplay between glucose variability, empagliflozin and cardiovascular death has not been explored. In the EMPA-REG OUTCOME trial, empagliflozin reduced the risk of cardiovascular death by 38%. We explore post-hoc the association between HbA1c variability and cardiovascular death, and the potential mediating effects of HbA1c variability on empagliflozin’s cardiovascular death reductions.Methods: In total, 7,020 patients with type 2 diabetes and established cardiovascular disease received placebo, empagliflozin 10 mg or 25 mg. We defined within-patient HbA1c variability as standard deviation, coefficient of variation and range of HbA1c measurements (%) post-baseline. First, we compared HbA1c variability until week 28 and 52 by Wilcoxon tests. We explored the association between cardiovascular death and HbA1c variability in placebo and pooled empagliflozin arms separately with landmark analyses at week 28 and 52, and additionally with HbA1c variability as a time-dependent co-variate. We used Cox regression models adjusted for baseline risk factors including changes in HbA1c from baseline to week 12, and the interaction term HbA1c variability* treatment.Results: HbA1c variability was lower with empagliflozin compared to placebo. In all Cox analyses, high HbA1c variability increased the risk for cardiovascular death in both treatment arms with no interaction with treatment: e.g.an increase in HbA1c variability of one unit for the standard deviation at week 28 was associated with a subsequent increased risk of CV death with HRs of 1.97 (95% CI 1.36, 2.84) and 1.53 (1.01, 2.31) in the placebo and empagliflozin groups, separately, interaction p-value 0.3615.Conclusions: HbA1c variability was reduced by empagliflozin and high values of HbA1c variability were associated with an increased risk of cardiovascular death. Empagliflozin’s reduction in cardiovascular death did not appear to be mediated by reductions in HbA1c variability.ClinicalTrials.gov number, NCT01131676

scholarly journals THE IMPORTANCE OF THE DIASTOLIC DYSFUNCTION IN THE CARDIOVASCULAR RISK STRATIFICATION OF NON-CARDIAC SURGICAL INTERVENTION

2018 ◽  
Vol 5 (5) ◽  
pp. 18-25
Author(s):  
O. N. Dzhioeva
Keyword(s):  
Risk Stratification ◽  
Diastolic Dysfunction ◽  
Perioperative Complications ◽  
Practical Interest ◽  
Cardiac Risk ◽  
Cardiovascular Complications ◽  
Cardiovascular Risks ◽  
Cardiac Events ◽  
Surgical Interventions ◽  
Negative Prognostic Factor

The article is an overview of foreign data on the evaluation of diastolic function disorders as a predictor of cardiovascular complications in non-cardiac surgical interventions. This problem is of significant practical interest, since in modern recommendations on the stratification of cardiac risk of perioperative complications, diastolic dysfunction is not identified as a negative prognostic factor. Although current guidelines on perioperative assessment of cardiovascular risks in extracardiac surgery do not evaluate diastolic dysfunction as a risk factor, more and more data indicate a higher incidence of serious adverse cardiac events, a longer hospital stay in patients with diastolic CHF. The article presents modern evidence supporting the need to include diastolic dysfunction in the risk stratification of non-cardiac surgical interventions.

scholarly journals Posthospital Cardiovascular Complications in Patients after Non-Cardiac Surgery

2021 ◽  
Vol 18 (4) ◽  
pp. 62-72
Author(s):  
D. A. Sokolov ◽  
P. A. Lyuboshevsky ◽  
I. N. Staroverov ◽  
I. A. Kozlov
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiac Surgery ◽  
Chronic Heart Failure ◽  
Cardiac Risk ◽  
Cardiovascular Complications ◽  
Cardiac Events ◽  
Risk Indices ◽  
Medium Risk ◽  
Potential Risk Factors

The objective: to analyze the incidence and spectrum of cardiovascular complications within 12 months after noncardiac surgery, as well as to assess the association of preoperative values of various cardiac risk indices (CRI) and other potential risk factors with the actual development of complications.Subjects and Methods. We analyzed data of medical records and telephone interviews of 141 patients aged 65 [60-71] years who had undergone non-cardiac surgery a year before the interview The operations were low risk in 13.5% of observations, medium risk in 64.5%, and high risk in 22%. A retrospective calculation of the Revised CRI (RCRI), Individual CRI (Khoronenko CRI), and the American College of Surgeons Perioperative Risk for Myocardial Infarction or Cardiac Arrest (MICA) was performed.Results. Cardiac events (myocardial infarction, decompensation of chronic heart failure, new arrhythmias, stroke, and/or the need to prescribe or escalate the dose of cardiovascular drugs and/or hospitalization for cardiac indications, and/or death from cardiovascular diseases) within 12 months after elective noncardiac surgeries were detected in 27.7% of cases, and in 2.1% of patient's death occurred due to cardiac disorders. Predictors of cardiac events were concomitant ischemic heart disease (OR = 2.777; 95% CI 1.286-5.966; p = 0.0093) and chronic heart failure (OR = 2.900; 95% CI 1.224-6.869; p = 0, 0155), RCRI (OR = 1.886; 95% CI 1.2-8-2.944; p = 0.005), Khoronenko CRI (OR = 3254.3; 95% CI 64.33-164,638; p = 0.0001), MICA (OR = 1.628; 95% CI 1.156-2.292; p = 0.005), creatininemia on the first postoperative day (OR = 1.023; 95% CI 1.010-1.061; p = 0.005), and propensity for bradycardia during surgery (OR = 0.945; 95% CI 0.908-0.983; p = 0.005). Combined analysis of Khoronenko's CRI and postoperative creatininemia provided a very good model: area under the ROC-curve - 0.823 (95% CI 0.728-0.641; p = 0.0002).Conclusion. All studied CRIs can be used to predict posthospital cardiac events; however, the most promising is a joint assessment of Khoronenko's CRI and postoperative creatinemia.

scholarly journals Underlying cardiovascular risk and major adverse cardiovascular events after acute respiratory infection: a population-based cohort study of over 4.2 million individuals in England, 2008-2018

2021 ◽  
Author(s):  
Jennifer Davidson ◽  
Amitava Banerjee ◽  
Liam Smeeth ◽  
Helen I McDonald ◽  
Daniel J Grint ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiovascular Risk ◽  
Cardiovascular Events ◽  
Respiratory Infections ◽  
Cardiovascular Complications ◽  
Major Adverse Cardiovascular Events ◽  
Mortality Data ◽  
Clinical Practice Research Datalink ◽  
Increased Risk ◽  
One Year

Background While acute respiratory infections (ARIs) can lead to cardiovascular complications, the effect of underlying cardiovascular risk profile on ARI incidence and cardiovascular complications in those without established cardiovascular disease (CVD) is unknown. Whether to consider individuals at raised cardiovascular risk a priority group for vaccination against respiratory infections therefore remains unclear. Methods We conducted a cohort study in individuals aged 40-64 years without established CVD or a chronic health condition eligible for influenza vaccination, using Clinical Practice Research Datalink GOLD and Aurum data from 01/09/2008-31/08/2018 linked to Hospital Episode Statistics Admitted Patient Care and Office for National Statistics mortality data from England. We classified cardiovascular risk based on diagnosed hypertension and overall predicted cardiovascular risk estimated using QRISK2 score (≥10% compared with <10%). Using multivariable Poisson regression models, we obtained incidence rate ratios (IRR) for ARI. Among individuals who had an ARI, we then used multivariable Cox regression to obtain hazard ratios (HR) for the risk of major adverse cardiovascular events (MACE) within one year of infection. Findings 4,212,930 individuals were included; 12.5% had hypertension and 14.4% had a QRISK2 score ≥10%. After adjusting for confounders, patients with hypertension (IRR 1.04, 95% CI 1.03-1.05) or QRISK2 score ≥10% (IRR 1.39, 1.37-1.40) had a higher incidence of ARI. Of the 442,408 individuals with an ARI, 4,196 had a MACE within one year of infection. After adjustment, hypertension (HR 1.98, 1.83-2.15) and QRISK2 score ≥10% (HR 3.65, 3.42-3.89) were associated with substantial increased risk of a MACE after infection. Interpretation People without diagnosed CVD but who have raised cardiovascular risk, measured by diagnosed hypertension or, in particular, overall predicted cardiovascular risk, have increased incidence of both ARI and cardiovascular complications following an ARI.

scholarly journals Office Blood Pressure Range and Cardiovascular Events in Patients With Hypertension: A Nationwide Cohort Study in South Korea

2021 ◽  
Author(s):  
Chang Hee Kwon ◽  
Woohyeun Kim ◽  
Jeong‐Hun Shin ◽  
Chan Joo Lee ◽  
Hyeon‐Chang Kim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Cardiovascular Events ◽  
Age Groups ◽  
Cardiovascular Death ◽  
Office Blood Pressure ◽  
Target Range ◽  
Major Cardiovascular Events ◽  
Increased Risk ◽  
Blood Pressure Range

Background It is unclear what office blood pressure (BP) is the optimal treatment target range in patients with hypertension. Methods and Results Using the Korean National Health Insurance Service database, we extracted the data on 479 359 patients with hypertension with available BP measurements and no history of cardiovascular events from 2002 to 2011. The study end point was major cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, or stroke. This cohort study evaluated the association of BP levels (<120/<70, 120–129/70–79, 130–139/80–89, 140–149/90–99, and ≥150/≥100 mm Hg) with MACE. During a median follow‐up of 9 years, 55 401 MACE were documented in our cohort. The risk of MACE was the lowest (adjusted hazard ratio [HR], 0.79; 95% CI, 0.76–0.84) at BP level of <120/<70 mm Hg, and was the highest (HR, 1.32; 95% CI, 1.29–1.36) at ≥150/≥100 mm Hg in comparison with 130 to 139/80 to 89 mm Hg. These results were consistent in all age groups and both sexes. Among patients treated with antihypertensive medication (n=237 592, 49.5%), in comparison with a BP level of 130 to 139/80 to 89 mm Hg, the risk of MACE was significantly higher in patients with elevated BP (≥140/≥90 mm Hg), but not significantly lower in patients with BP of <130/<80 mm Hg. Low BP <120/70 mm Hg was associated with increased risk of all‐cause or cardiovascular death in all age groups. Conclusions BP level is significantly correlated with the risk of MACE in all Korean patients with hypertension. However, there were no additional benefits for MACE amongst those treated for hypertension with BP <120/70 mm Hg.

scholarly journals Associations Between Malignancy and Cardiovascular Complications Following Emergency Laparotomy – a Retrospective Cohort Study

2020 ◽  
Author(s):  
Rasmus Peuliche Vogelsang ◽  
Jacob Hartmann Søby ◽  
Mai-Britt Tolstrup ◽  
Jakob Burcharth ◽  
Sarah Ekeløf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Malignant Disease ◽  
Multivariate Logistic Regression Analysis ◽  
Cardiovascular Complications ◽  
Emergency Laparotomy ◽  
Asa Score ◽  
Increased Risk

Abstract Background Several studies have shown a possible causal relationship between the occurrence of systemic inflammation in patients with malignant disease and increased risk of cardiovascular events. Our objective was to estimate the association between malignant disease and postoperative cardiovascular complications. Secondarily, we aimed to identify risk factors for postoperative cardiovascular complications. Methods We conducted a retrospective cohort study of all patients ≥ 18 years undergoing emergency laparotomy between 2010 and 2016 at the Department of Surgery at Zealand University Hospital, Denmark. Complications were graded according to the Clavien-Dindo (CD) classification of surgical complications. A multivariate logistic regression analysis was performed to estimate the association between malignant disease and cardiovascular complications within 30 days of emergency laparotomy and to identify other risk factors for postoperative cardiovascular complications after emergency laparotomy. Results We identified 1188 patients ≥ 18 years undergoing emergency laparotomy between 2010 and 2016, in which 254 (21%) had malignant disease. Within 30 days of emergency laparotomy, 89 (9.5%) of patients without malignancy died, as compared with 45 (18%) of patients with malignancy (p < 0.001). Severe cardiovascular complication graded CD 3–5 occurred in 93 (8%) of all patients within 30 days of emergency laparotomy. We found no association between malignancy and postoperative cardiovascular complications. Increasing age and ASA physical status classification system (ASA) score ≥ III were the only independent risk factors of cardiovascular complications graded CD 3–5. Conclusions Malignancy was not associated with postoperative cardiovascular complications after emergency laparotomy. Risk factors for major cardiovascular complications after emergency abdominal surgery were age and ASA score ≥ III.

Long term cardiac outcomes and anthracycline exposure in breast cancer survivors: A retrospective cohort data linkage and competing risks analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 553-553
Author(s):  
Kelly Rust ◽  
Jeremy Walker ◽  
Richard Stoker ◽  
Sarah Wild ◽  
Peter Henriksen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Competing Risks ◽  
Primary Outcome ◽  
Cardiac Risk ◽  
Cardiac Events ◽  
Breast Cancer Death ◽  
Cardiac Outcomes ◽  
Increased Risk ◽  
Anthracycline Chemotherapy

553 Background: Anthracycline chemotherapy is used frequently in adjuvant breast cancer treatment but there is clinical trial evidence of cardiac toxicity. Attempts to quantify this risk in routine care have been limited by follow up time & confounding factors. The aim of this project was to exploit rich Scottish NHS datasets for this purpose. Methods: Patients treated surgically for stage I-III invasive breast cancer between 2000 & 2010 were identified from a local cancer database (Edinburgh Cancer Centre). Outcomes were captured by linkage to the Scottish Morbidity & death Records. Follow-up was until March 2016. The primary outcome was a cardiac event or cardiac death, identified from coding. Analysis used the Latouche approach (estimating cause-specific hazards & sub-distribution hazards) for the primary outcome & the competing risks of death from breast cancer & death from other causes. Results were adjusted for age, deprivation (SIMD), co-morbidity (Charlson), year of diagnosis, side of radiotherapy, cancer stage, grade, ER & HER 2 status. Results: 4080 patients were identified, 1658 received an anthracycline containing regime, 297 received non-anthracycline chemotherapy & 2125 received no chemotherapy. A total of 33946 women years were analysed. During median follow up of 8.2 years there were 448 cardiac events & 559 breast cancer deaths. After adjustments there was no association between anthracycline use & cardiac outcomes (HR 0.9, 95% CI 0.67-1.21). There was an increased risk of breast cancer death (HR 1.66, 95% CI 1.28-2.16).Age & Charlson score were associated with an increased cardiac risk. Stage & grade were statistically associated with breast cancer death. Conclusions: No increased risk of cardiac events was seen in women treated with anthracyclines, they can be safely used in carefully selected patients. This data suggests selection may be over-cautious, a lower threshold for treatment may lead to improved breast cancer outcomes. Rich routine health datasets & appropriate analysis methods make outcomes monitoring feasible in Scotland. Oncologists are skilled at assessing both cardiac risk factors & breast cancer risk.

Loperamide and cardiac events: Is high-dose use still safe for chemotherapy-induced diarrhea?

2017 ◽  
Vol 24 (8) ◽  
pp. 634-636 ◽  
Author(s):  
Mário L de Lemos ◽  
Jolene Guenter ◽  
Victoria Kletas
Keyword(s):  
Daily Intake ◽  
Extended Period ◽  
Torsades De Pointes ◽  
Serum Levels ◽  
Cardiac Risk ◽  
High Dose ◽  
Cardiac Events ◽  
The Us ◽  
High Doses ◽  
Higher Doses

High-dose loperamide is often used for the acute management of chemotherapy-induced diarrhea, with a maximum daily dosing of up to 24 mg. Recently, the US Food and Drug Administration has issued a warning that loperamide can cause rare serious cardiac events, including QT prolongation, torsades de pointes, cardiac arrest and death. Most events were reported in patients taking very high doses for an extended period of time. Daily intake ranged from 64 mg to 1600 mg, often continuously for weeks or months. In addition, the reported serum levels of loperamide ranged from 22 ng/mL to 210 ng/mL, which is likely significantly higher than that expected from patients taking the recommended doses for chemotherapy-induced diarrhea. Overall, the incidence of serious cardiac events associated with loperamide remains low. In balance, the risk of uncontrolled complications from chemotherapy-induced diarrhea is likely greater than the rare cardiac risk associated with the chronic misuse of much higher doses of loperamide.

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