Comparision of the risk of cardiovascular events and death in patients treated with degarelix compared with LHRH agonists.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 42-42 ◽  
Author(s):  
Peter C. Albertsen ◽  
Jan Nilsson ◽  
Laurence Klotz ◽  
Heather Payne ◽  
Egbert van der Meulen ◽  
...  
Keyword(s):  
Gnrh Antagonist ◽  
First Year ◽  
Lhrh Agonist ◽  
Event Analysis ◽  
Cvd Risk ◽  
Lhrh Agonists ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Treatment Data ◽  
Cv Disease

42 Background: LHRH agonists are used to treat patients (pts) with advanced prostate cancer and have been associated with an increased risk of cardiovascular (CV) events and related deaths. Degarelix is a GnRH antagonist that appears to mitigate this risk. Methods: Results were pooled from 2328 pts participating in 6 prospective randomised trials. Most pts (n=1,686) received 1 year of GnRH antagonist or LHRH agonist treatment; the remainder (n=642) had 3–7 months’ treatment. Data were classified based on the MedDRA system and analysed using Kaplan Meier plots and a Cox proportional hazard model. Event analysis was based on death from any cause or CV event defined as arterial embolic/thrombotic; haemorrhagic or ischemic cerebrovascular; myocardial infarction or other ischemic heart disease. High risk pts were defined as men with a baseline CV disease (CVD) history. Results: Treatment groups (GnRH antagonist, n=1,491 [degarelix]; LHRH agonist, n=837 [goserelin, n=458; leuprolide, n=379]) were balanced for baseline characteristics and CVD history (31% vs. 29%). Characteristics associated with CVD (e.g. statin medication, elevated blood pressure, diabetes, cholesterol >6.2 mmol/L) were similar between groups. The risk of a CV event or death was significantly lower in pts receiving degarelix during the first year of treatment (see Table). In pts with baseline CVD the findings remained significant. In pts with no baseline CVD, there was no difference in subsequent CVD events or death in either group. In analysis by time to CV event only in all pts and pts with baseline CVD (see Table), men receiving GnRH antagonist had a significantly lower risk of CV events. Conclusions: In all pts treated with a GnRH antagonist (degarelix) risk of a CV event or death was significantly lower than in pts receiving an LHRH agonist over a treatment period of up to 1 year. In pts with baseline CVD, risk reduction remained significant at ~50%. [Table: see text]

Cardiovascular Risk in Rheumatoid Arthritis and Mechanistic Links: From Pathophysiology to Treatment

2020 ◽  
Vol 18 (5) ◽  
pp. 431-446 ◽  
Author(s):  
George E. Fragoulis ◽  
Ismini Panayotidis ◽  
Elena Nikiphorou
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Current Evidence ◽  
Pharmacological Intervention ◽  
Cvd Risk ◽  
The Past ◽  
Increased Risk ◽  
Cv Disease ◽  
Obesity Hypertension ◽  
Inflammatory Burden

Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis. Inflammation, however, can spread beyond the joints to involve other organs. During the past few years, it has been well recognized that RA associates with increased risk for cardiovascular (CV) disease (CVD) compared with the general population. This seems to be due not only to the increased occurrence in RA of classical CVD risk factors and comorbidities like smoking, obesity, hypertension, diabetes, metabolic syndrome, and others but also to the inflammatory burden that RA itself carries. This is not unexpected given the strong links between inflammation and atherosclerosis and CVD. It has been shown that inflammatory cytokines which are present in abundance in RA play a significant role in every step of plaque formation and rupture. Most of the therapeutic regimes used in RA treatment seem to offer significant benefits to that end. However, more studies are needed to clarify the effect of these drugs on various parameters, including the lipid profile. Of note, although pharmacological intervention significantly helps reduce the inflammatory burden and therefore the CVD risk, control of the so-called classical risk factors is equally important. Herein, we review the current evidence for the underlying pathogenic mechanisms linking inflammation with CVD in the context of RA and reflect on the possible impact of treatments used in RA.

scholarly journals Early Probiotic Supplementation and the Risk of Celiac Disease in Children at Genetic Risk

Nutrients ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 1790 ◽  
Author(s):  
Ulla Uusitalo ◽  
Carin Andren Aronsson ◽  
Xiang Liu ◽  
Kalle Kurppa ◽  
Jimin Yang ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Dietary Supplements ◽  
Genetic Risk ◽  
First Year ◽  
Event Analysis ◽  
Time To Event ◽  
Probiotic Supplementation ◽  
Increased Risk ◽  
Regulatory Effects ◽  
First Year Of Life

Probiotics are linked to positive regulatory effects on the immune system. The aim of the study was to examine the association between the exposure of probiotics via dietary supplements or via infant formula by the age of 1 year and the development of celiac disease autoimmunity (CDA) and celiac disease among a cohort of 6520 genetically susceptible children. Use of probiotics during the first year of life was reported by 1460 children. Time-to-event analysis was used to examine the associations. Overall exposure of probiotics during the first year of life was not associated with either CDA (n = 1212) (HR 1.15; 95%CI 0.99, 1.35; p = 0.07) or celiac disease (n = 455) (HR 1.11; 95%CI 0.86, 1.43; p = 0.43) when adjusting for known risk factors. Intake of probiotic dietary supplements, however, was associated with a slightly increased risk of CDA (HR 1.18; 95%CI 1.00, 1.40; p = 0.043) compared to children who did not get probiotics. It was concluded that the overall exposure of probiotics during the first year of life was not associated with CDA or celiac disease in children at genetic risk.

Fractures and health care resource use in cancer patients with chemotherapy-associated peripheral neuropathy (CAPN).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e13038-e13038
Author(s):  
Arijit Ganguli ◽  
Patrick J Reilly ◽  
Saurabh Ray
Keyword(s):  
Peripheral Neuropathy ◽  
Cancer Patients ◽  
Resource Use ◽  
Index Date ◽  
Event Analysis ◽  
Office Visits ◽  
Inclusion Criteria ◽  
Time To Event ◽  
Kaplan Meier ◽  
Increased Risk

e13038 Background: Chemotherapy has been associated with increased risk of fractures1. This study examines the real-world incidence of fractures and healthcare resource use (HRU) that may be associated with CAPN in cancer patients. Methods: A retrospective analysis utilized a national health insurer claims -database (2001-2009), to identify patients ≥18 yrs with a cancer ICD-9-code (140-239) and a chemotherapy drug code (J9xxx). The 1st chemotherapy date was the "index date." Patients with a record of peripheral neuropathy (PN) in the pre-index date were excluded. Patients with a PN post-index were matched with no-PN post-index (non-PN) based on gender, age and index date. Both groups were compared for number of fractures, HRU (hospital outpatient (OP), office, and emergency-room [ER] visits) and all-cause costs in their 365-days post-index period. Time to 1st fracture post-index was compared using Kaplan Meier time to event analysis. Results: Of 34,625 patient meeting the inclusion criteria, 1675 patients (4.3%) formed the PN group and were matched to non-PN group. At baseline, mean age was 54.9 yrs, 62.5% were females, and no difference in % of bone metastasis (p=0.12) between the groups. In PN group, 5.3% (n=87) had a fracture 365-days post-index compared to 3.5% (n=58) in non-PN group (p<0.05). Mean days to fracture from index date in PN group was shorter than the non-PN group (150.9 vs. 153.4, p<0.05). In PN group, annual mean number of OP visit (14.6 vs. 12.0, p<0.0001), ER visit (0.47 vs. 0.30, p<0.001), and office visits (30.4 vs. 23.3, p<0.0001), were higher compared to non-PN group. Annual healthcare cost of PN patients was 21% higher than non-PN patients ($64,578 vs. $53,221) and CAPN-related cost in PN group was estimated to be $5,580 annually. Conclusions: Patients with CAPN were associated with higher incidence of fractures, HRU and cost.

scholarly journals POS0796 SURVIVAL OF GIANT CELL ARTERITIS PATIENTS IN SLOVENIA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 650.1-650
Author(s):  
A. Hočevar ◽  
A. Viršček ◽  
R. Jese ◽  
M. Tomsic ◽  
Z. Rotar
Keyword(s):  
General Population ◽  
Survival Curve ◽  
Standardized Mortality Ratio ◽  
First Year ◽  
Risk Of Death ◽  
Slovenian Population ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Standardized Mortality Ratios

Background:Recent meta-analysis reported no difference in the long-term mortality of GCA patients at a population level, but an increased mortality in hospital-based cohorts1.Objectives:The aim of our study was to evaluate for the first time the survival of GCA patients in Slovenia.Methods:We included patients with clinical diagnosis of GCA supported by histology or imaging diagnosed between September 2011 and December 2019 and prospectively followed at our secondary/tertiary rheumatology center. To evaluate mortality the censor date of 24. June 2020 was used. Kaplan–Meier analysis was used to analyze mortality. Standardized mortality ratio (SMR) was calculated using data of age matched Slovenian population as the reference.Results:Between September 2011 and December 2019 we identified 309 new GCA patients (203 (65.7%) females, median (IQR) age 74.9 (67.7–80.1.7), range 53.7 to 97.5 years). Patients were followed (until death or censor date) of a median (IQR) 33.3 (17.5-60.8) months. Until the censor date 51 (16.5%) GCA patients died (24 females, 27 males). We found no significant sex related differences in the net survival estimates during the first five years of follow up (p=0.68). Figure 1 shows the survival curve of GCA patients and general population as a comparator according to Kaplan–Meier analysis. In the first year following GCA diagnosis the mortality rate was 1.9 times higher compared to general Slovenian population (95% CI 1.19 - 2.88, p=0.03). For patients who survived the first year after diagnosis the mortality was comparable to the general population (Table 1).Figure 1.Survival curve according to Kaplan–Meier analysis in GCATable 1.Standardized mortality ratios of patients who survived the first year after diagnosing GCA (ie. were followed at least one year) compared to the general populationYearsof FUObserved deathsExpected deathsSMR (95%CI)P-value2119.71.14 (0.57-2.03)0.75331416.50.85 (0.46-1.43)0.62642121.60.97 (0.60-1.49)0.98752525.01.00 (0.65-1.48)0.92162627.60.94 (0.61-1.38)0.831Legend: FU follow up; SMR Standardized mortality ratios; CI confidence intervalConclusion:GCA patients had an increased risk of death in the first year from the GCA diagnosis.References:[1]Hill CL, et al. Semin Arthritis Rheum. 2017;46(4):513-9.Disclosure of Interests:None declared

Degarelix versus LHRH agonists: Differential skeletal and urinary tract outcomes from an analysis of six comparative randomized clinical trials.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 68-68
Author(s):  
E. David Crawford ◽  
Neal Shore ◽  
Kurt Miller ◽  
Bertrand Tombal ◽  
Cathrina Kathrup ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Randomized Clinical Trials ◽  
Disease Stage ◽  
Rank Test ◽  
Lhrh Agonist ◽  
Gnrh Antagonists ◽  
Lhrh Agonists ◽  
Kaplan Meier ◽  
Urinary Infections ◽  
Urinary Tract Symptoms

68 Background: The use of ADT in men with prostate cancer is well established. GnRH antagonists have a mode of action distinct to that of LHRH agonists and comparative trials have shown differences in efficacy and safety between these agents. Adverse events (AE) from the musculoskeletal and renal and urinary systems have now been analysed. Methods: Results were pooled from 6 prospective, comparative randomised trials (n=2328). Most patients (pts) received 1 year of degarelix or LHRH agonist treatment (n=1686); the remaining men had 3–7 months’ treatment (n=642). AEs were analysed using Kaplan Meier plots and a log-rank test for homogeneity on relevant groups of MedDRA terms. Results: Treatment groups (degarelix, n=1491; LHRH agonist, n=837) were balanced for baseline characteristics such as age, testosterone, PSA and disease stage. In men with metastatic disease alkaline phosphatase (ALP) was reduced to a greater extent with degarelix (p=0.0373) throughout the year. Overall probability of fracture (<1% vs. 2%, p=0.0411) and incidence of joint related AEs (4% vs. 6%, p=0.0116) were significantly lower for degarelix-treated men. Incidence of muscle or bone pain was lower for degarelix (9% vs. 12%, p=0.0822). Incidence of urinary infections (UI) was reduced (5% vs. 8% with agonists) and time to first UI was significantly increased (p=0.0010) with degarelix. Overall probability of any renal or urinary tract AEs, including lower urinary tract symptoms (LUTS), was significantly lower in pts receiving degarelix (p<0.0001). Consistent with fewer skeletal and urinary tract AEs indicating better disease control, men with baseline PSA >50 ng/mL had significantly higher PSA PFS compared to agonist treated pts. OS during 1 year of treatment was significantly higher for degarelix pts (98.3% vs. 96.7%, p=0.0329). Conclusions: This analysis of 2,328 men shows degarelix-treated men had lower ALP, significantly fewer fractures, a lower incidence of urinary tract symptoms and higher overall survival than pts receiving an LHRH agonist over one year. Control of such disease symptoms is consistent with previous data on a significantly lower risk of PSA PFS during the first year of treatment.

DAPSA, carotid plaque and cardiovascular events in psoriatic arthritis: a longitudinal study

2020 ◽  
Vol 79 (10) ◽  
pp. 1320-1326
Author(s):  
Steven Ho Man Lam ◽  
Isaac T Cheng ◽  
Edmund K Li ◽  
Priscilla Wong ◽  
Jolie Lee ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Carotid Plaque ◽  
Cohort Analysis ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Risk Scores ◽  
Cvd Risk ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
Cv Disease

ObjectiveTo examine whether Disease Activity in Psoriatic Arthritis (DAPSA) reflecting the inflammatory component of psoriatic arthritis (PsA) can predict cardiovascular (CV) events independent of traditional CV risk factors and subclinical carotid atherosclerosis.MethodsA cohort analysis was performed in patients with PsA who had been followed since 2006. The outcome of interest was first CV event. Four different CV disease (CVD) risk scores and DAPSA were computed at baseline. The presence of carotid plaque (CP) and carotid intima-media thickness (CIMT) was also determined in a subgroup of patients using high-resolution ultrasound. The association between DAPSA, CVD risk scores, CP, CIMT and the occurrence of CV events was assessed using Cox proportional hazard models.Results189 patients with PsA (mean age: 48.9 years; male: 104 (55.0%)) were recruited. After a median follow-up of 9.9 years, 27 (14.3%) patients developed a CV event. Higher DAPSA was significantly associated with an increased risk of developing CV events (HR: 1.04, 95% CI (1.01 to 1.08), p=0.009). The association remained significant after adjusting for all CV risk scores in the multivariable models. In the subgroup analysis, 154 patients underwent carotid ultrasound assessment and 23 (14.9%) of them experienced a CV event. CP was associated with increased risk of developing CV events after adjusting for three CV risk scores and DAPSA, with HR ranging from 2.35 to 3.42.ConclusionHigher DAPSA and the presence of CP could independently predict CVD events in addition to traditional CV risk scores in patients with PsA.

scholarly journals Tuberculosis and risk of acute myocardial infarction: a propensity score-matched analysis

2017 ◽  
Vol 145 (7) ◽  
pp. 1363-1367 ◽  
Author(s):  
M. A. HUAMAN ◽  
R. J. KRYSCIO ◽  
C. J. FICHTENBAUM ◽  
D. HENSON ◽  
E. SALT ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Propensity Scores ◽  
Cvd Risk ◽  
Tuberculosis Patients ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
Tuberculosis Disease

SUMMARYSeveral pathogens have been associated with increased cardiovascular disease (CVD) risk. Whether this occurs with Mycobacterium tuberculosis infection is unclear. We assessed if tuberculosis disease increased the risk of acute myocardial infarction (AMI). We identified patients with tuberculosis index claims from a large de-identified database of ~15 million adults enrolled in a U.S. commercial insurance policy between 2008 and 2010. Tuberculosis patients were 1:1 matched to patients without tuberculosis claims using propensity scores. We compared the occurrence of index AMI claims between the tuberculosis and non-tuberculosis cohorts using Kaplan–Meier curves and Cox Proportional Hazard models. Data on 2026 patients with tuberculosis and 2026 propensity-matched patients without tuberculosis were included. AMI was more frequent in the tuberculosis cohort compared with the non-tuberculosis cohort, 67 (3·3%) vs. 32 (1·6%) AMI cases, respectively, P < 0·01. Tuberculosis was associated with an increased risk of AMI (adjusted hazard ratio (HR) 1·98, 95% confidence intervals (CI) 1·3–3·0). The results were similar when the analysis was restricted to pulmonary tuberculosis (adjusted HR 2·43, 95% CI 1·5–4·1). Tuberculosis was associated with an increased risk of AMI. CVD risk assessment should be considered in tuberculosis patients. Mechanistic studies of tuberculosis and CVD are warranted.

Cardiovascular Complications of Sleep Disorders: A Better Night’s Sleep for a Healthier Heart / From Bench to Bedside

2020 ◽  
Vol 19 (2) ◽  
pp. 210-232 ◽  
Author(s):  
Theodora A. Manolis ◽  
Antonis A. Manolis ◽  
Evdoxia J. Apostolopoulos ◽  
Helen Melita ◽  
Antonis S. Manolis
Keyword(s):  
Sleep Disorders ◽  
Disease Risk ◽  
Behavioral Therapy ◽  
Benzodiazepine Receptor ◽  
Cardiovascular Complications ◽  
Gamma Aminobutyric Acid ◽  
Acid Type ◽  
Increased Risk ◽  
Cv Disease ◽  
Meta Analyses

: Sleep is essential to and an integral part of life and when lacking or disrupted, a multitude of mental and physical pathologies ensue, including cardiovascular (CV) disease, which increases health care costs. Several prospective studies and meta-analyses show that insomnia, short (<7h) or long (>9h) sleep and other sleep disorders are associated with an increased risk of hypertension, metabolic syndrome, myocardial infarction, heart failure, arrhythmias, CV disease risk and/or mortality. The mechanisms by which insomnia and other sleep disorders lead to increased CV risk may encompass inflammatory, immunological, neuro-autonomic, endocrinological, genetic and microbiome perturbations. Guidelines are emerging that recommend a target of >7 h of sleep for all adults >18 years for optimal CV health. Treatment of sleep disorders includes cognitive-behavioral therapy considered the mainstay of non-pharmacologic management of chronic insomnia, and drug treatment with benzodiazepine receptor agonists binding to gamma aminobutyric acid type A (benzodiazepine and non-benzodiazepine agents) and some antidepressants. However, observational studies and meta-analyses indicate an increased mortality risk of anxiolytics and hypnotics, although bias may be involved due to confounding and high heterogeneity in these studies. Nevertheless, it seems that the risk incurred by the non-benzodiazepine hypnotic agents (Z drugs) may be relatively less than the risk of anxiolytics, with evidence indicating that at least one of these agents, zolpidem, may even confer a lower risk of mortality in adjusted models. All these issues are herein reviewed.

Metabolic Complications and Kidney Transplantation: Focus on Glycaemia and Dyslipidaemia

2020 ◽  
Vol 18 (3) ◽  
pp. 273-281 ◽  
Author(s):  
Panagiotis Anagnostis ◽  
Stavroula Α. Paschou ◽  
Eleftherios Spartalis ◽  
Gerardo Sarno ◽  
Paride De Rosa ◽  
...  
Keyword(s):  
Graft Function ◽  
Current Data ◽  
Optimal Management ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cvd Risk ◽  
Oral Hypoglycaemic Agents ◽  
Metabolic Complications ◽  
Increased Risk ◽  
Regimen Modification

Post-transplant diabetes mellitus (PTDM) and dyslipidaemia are the most common metabolic complications in kidney transplant recipients (KTR). They are associated with a higher risk of lower graft function and survival, as well as an increased risk of cardiovascular disease (CVD). The aim of this review is to provide current data on the epidemiology, pathophysiology and optimal management of these two principal metabolic complications in KTR. Several risk factors in this metabolic milieu are either already present or emerge after renal transplantation, such as those due to immunosuppressive therapy. However, the exact pathogenic mechanisms have not been fully elucidated. Awareness of these disorders is crucial to estimate CVD risk in KTR and optimize screening and therapeutic strategies. These include lifestyle (preferably according to the Mediterranean pattern) and immunosuppressive regimen modification, as well as the best available anti-diabetic (insulin or oral hypoglycaemic agents) and hypolipidaemic (e.g. statins) regimen according to an individual’s metabolic profile and medical history.

scholarly journals Coeliac disease is associated with depression in children and young adults with type 1 diabetes: results from a multicentre diabetes registry

2021 ◽  
Author(s):  
Sascha René Tittel ◽  
◽  
Désirée Dunstheimer ◽  
Dörte Hilgard ◽  
Burkhild Knauth ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Young Adults ◽  
Coeliac Disease ◽  
Diabetes Patient ◽  
Routine Care ◽  
Diabetes Registry ◽  
Increased Risk ◽  
Treatment Data ◽  
Children And Young Adults

Abstract Aims To analyse the association between coeliac disease (CD) and depression in children, adolescents, and young adults with type 1 diabetes (T1D). Methods We included 79,067 T1D patients aged 6–20 years, with at least six months of diabetes duration, and treatment data between 1995 and 2019 were documented in the diabetes patient follow-up registry. We categorized patients into four groups: T1D only (n = 73,699), T1 + CD (n = 3379), T1D + depression (n = 1877), or T1D + CD + depression (n = 112). Results CD and depression were significantly associated (adjusted OR: 1.25 [1.03–1.53]). Females were more frequent in both the depression and the CD group compared with the T1D only group. Insulin pumps were used more frequently in T1D + CD and T1D + depression compared with T1D only (both p < .001). HbA1c was higher in T1D + depression (9.0% [8.9–9.0]), T1D + CD + depression (8.9% [8.6–9.2]), both compared with T1D only (8.2% [8.2–8.2], all p < .001). We found comorbid autism, attention deficit hyperactivity disorder, anxiety, schizophrenia, and eating disorders more frequently in the T1D + CD + depression group compared with T1D only (all p < .001). Conclusions CD and depression are associated in young T1D patients. The double load of T1D and CD may lead to an increased risk for depression. Depression was associated with additional psychological and neurological comorbidities. Aside from imperative CD screening after T1D diagnosis and regular intervals, depression screening might be helpful in routine care, especially in patients with diagnosed CD.

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