scholarly journals Association Between SGLT2is and Cardiovascular and Respiratory Diseases: A Meta-Analysis of Large Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Dao-Gen Yin ◽  
Mei Qiu ◽  
Xue-Yan Duan
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Cardiovascular Diseases ◽  
Pulmonary Disease ◽  
Respiratory Diseases ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Meta Analyses

The association between sodium-glucose cotransporter 2 inhibitors (SGLT2is) and various cardiovascular and respiratory diseases is unestablished. This meta-analysis aimed to explore whether use of SGLT2is is significantly associated with the occurrences of 80 types of cardiovascular diseases and 55 types of respiratory diseases. Large randomized trials of SGLT2is were included in analysis. Meta-analysis was conducted to synthesize risk ratio (RR) and 95% confidence interval (CI). Nine large trials were included in analysis. Compared to placebo, SGLT2is were associated with the reduced risks of 9 types of cardiovascular diseases (e.g., atrial fibrillation [RR 0.78, 95% CI 0.67-0.91], bradycardia [RR 0.60, 95% CI 0.40-0.89], and hypertensive emergency [RR 0.29, 95% CI 0.12-0.72]) and 11 types of respiratory diseases (e.g., chronic obstructive pulmonary disease [RR 0.77, 95% CI 0.61-0.97], asthma [RR 0.57, 95% CI 0.35-0.95], and sleep apnoea syndrome [RR 0.36, 95% CI 0.15-0.87]). The results of random-effects meta-analysis were similar with those of fixed-effects meta-analysis. No heterogeneity or only little heterogeneity was found in most meta-analyses. No publication bias was observed in most of the meta-analyses conducted in this study. SGLT2is were not significantly associated with the other 115 cardiovascular and respiratory diseases. SGLT2is are associated with the reduced risks of 9 types of cardiovascular diseases (e.g., atrial fibrillation, bradycardia, and hypertensive emergency) and 11 types of respiratory diseases (e.g., chronic obstructive pulmonary disease, asthma, and sleep apnoea syndrome). This proposes the potential of SGLT2is to be used for prevention of these cardiovascular and respiratory diseases.

Atrial fibrillation and sleep apnoea and chronic obstructive pulmonary disease

ESC CardioMed ◽  
2018 ◽  
pp. 2235-2237
Author(s):  
Tauseef Akhtar ◽  
Jared D. Miller ◽  
Hugh Calkins
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Risk Factor Modification ◽  
Obstructive Sleep ◽  
P Rate

Rate control, rhythm control, and anticoagulation are well entrenched as the three central pillars of atrial fibrillation (AF) management. Risk factor modification of other associated co-morbidities is now emerging as a critical fourth pillar in the prevention and management of AF. Obstructive sleep apnoea and chronic obstructive pulmonary disease, in particular, have important implications in the development of AF and appropriate selection of therapy. This chapter reviews the pathophysiology and clinical evidence linking these conditions with AF. In addition, it discusses important considerations in the management of concurrent AF and obstructive sleep apnoea or chronic obstructive pulmonary disease.

Atrial fibrillation and sleep apnoea and chronic obstructive pulmonary disease

ESC CardioMed ◽  
2018 ◽  
pp. 2235-2237
Author(s):  
Jared D. Miller ◽  
Hugh G. Calkins
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Risk Factor Modification ◽  
Obstructive Sleep ◽  
P Rate

Rate control, rhythm control, and anticoagulation are well entrenched as the three central pillars of atrial fibrillation (AF) management. Risk factor modification of other associated co-morbidities is now emerging as a critical fourth pillar in the prevention and management of AF. Obstructive sleep apnoea and chronic obstructive pulmonary disease, in particular, have important implications in the development of AF and appropriate selection of therapy. This chapter reviews the pathophysiology and clinical evidence linking these conditions with AF. In addition, it discusses important considerations in the management of concurrent AF and obstructive sleep apnoea or chronic obstructive pulmonary disease.

scholarly journals Prevalence, management and impact of chronic obstructive pulmonary disease in atrial fibrillation: a systematic review and meta-analysis of 4,200,000 patients

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
GF Romiti ◽  
B Corica ◽  
E Pipitone ◽  
M Vitolo ◽  
V Raparelli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Adverse Outcomes ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf AF-COMET Collaborative Group Background Multimorbidity is a major concern in patients with atrial fibrillation (AF). Among other diseases, the prevalence of chronic obstructive pulmonary disease (COPD) in these patients is unclear, and its association with adverse outcomes is often overlooked. Moreover, uncertainties on the treatment of patients with both AF and COPD still exist, and may lead to undertreatment. Purpose The aim of this study is to estimate the prevalence of COPD, and its impact on management and outcomes in patients with AF. Methods A systematic review and meta-analysis was conducted according to PRISMA guidelines. All studies reporting the prevalence of COPD in AF patients were included and pooled. Data on comorbidities, beta-blockers (BBs) and oral anticoagulant (OAC) prescription, and outcomes (all-cause death, cardiovascular death, ischemic stroke, major bleeding) were pooled and compared according to COPD status; the impact of BBs on outcomes in patients with COPD was also investigated. All analyses were performed using random-effect models; subgroup analysis and meta-regressions were also performed to account for heterogeneity. Results Among 46 studies, the pooled prevalence of COPD was 13% (95% Confidence Intervals (CI): 10-16%), with high heterogeneity between studies; significant differences were found according to geographical locations and definition of COPD. A multivariable meta-regression model which included age, female sex, history of hypertension, diabetes and chronic heart failure (CHF) was able to explain a significant proportion of the heterogeneity (R2 = 69.8%). COPD was associated with a higher prevalence of diabetes, coronary artery disease, CHF and stroke (Fig. 1, panel A), as well as higher CHA2DS2-VASc scores and age (Fig. 1, panel B), and lower probability of BB prescription (Odds Ratio (OR): 0.77, 95%CI: 0.61-0.98). Patients with COPD showed higher risk of all-cause death (OR: 2.22, 95%CI: 1.93-2.55), cardiovascular death (OR: 1.84, 95%CI: 1.39-2.43) and major bleeding (OR: 1.45, 95%CI: 1.17-1.80) (Fig.1, Panel C); no significant differences in outcomes were observed according to BBs use in AF patients with COPD (Fig. 1, panel D). Conclusion COPD is common in AF, being found in 1 every 8 patients, and is associated with an increased burden of comorbidities, differential management and worse outcomes, with more than two-fold higher risk of all-cause death and increased risk of CV death and major bleeding. Therapy with BBs does not increase the risk of adverse outcomes in these patients. Abstract Figure.

scholarly journals Answering Complex Hierarchy Questions in Network Meta-analysis

2021 ◽  
Author(s):  
Theodoros Papakonstantinou ◽  
Georgia Salanti ◽  
Dimitris Mavridis ◽  
Gerta Rücker ◽  
Guido Schwarzer ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Health Outcome ◽  
Pulmonary Disease ◽  
Clinical Relevance ◽  
Meta Analysis ◽  
Simulation Method ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Stepwise Approach ◽  
Meta Analyses

Abstract Background: Network meta-analysis estimates all relative effects between competing treatments and can produce a treatment hierarchy from the most to the least desirable option according to a health outcome. While about half of the published network meta-analyses present such a hierarchy, it is rarely the case that it is related to a clinically relevant decision question. Methods: We first define treatment hierarchy and treatment ranking in a network meta-analysis and suggest a simulation method to estimate the probability of each possible hierarchy to occur. We then propose a stepwise approach to express clinically relevant decision questions as hierarchy questions and quantify the uncertainty of the criteria that constitute them. The steps of the approach are summarized as follows: a) a question of clinical relevance is defined, b) the hierarchies that satisfy the defined question are collected and c) the frequencies of the respective hierarchies are added; the resulted sum expresses the certainty of the defined set of criteria to hold. We then show how the frequencies of all possible hierarchies relate to common ranking metrics. Results: We exemplify the method and its implementation using two networks. The first is a network of four treatments for chronic obstructive pulmonary disease where the most probable hierarchy has a frequency of 28%. The second is a network of 18 antidepressants, among which Vortioxetine, Bupropion and Escitalopram occupy the first three ranks with frequency 19%.Conclusions: The developed method offers a generalised approach of producing treatment hierarchies in NMA, which moves towards attaching treatment ranking to a clear decision question, relevant to all or a subset of competing treatments.

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