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Song Q, Wang Q, Wu D, Zhang Z, Chen M, Fu C, Li M, Wang X, Zhao Y, Zhu D. Association between duration, initiation time, routes, and formulations of menopausal hormone therapy use and Alzheimer disease in women: A systematic review and meta-analysis. J Pharmacol Exp Ther 2025; 392:103554. [PMID: 40220453 DOI: 10.1016/j.jpet.2025.103554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 03/09/2025] [Accepted: 03/11/2025] [Indexed: 04/14/2025] Open
Abstract
The purpose of this study was to investigate the effect of menopausal hormone therapy (MHT) on the risk of Alzheimer disease (AD) by examining its duration, initiation time, routes of administration, and formulations through systematic review and meta-analysis. PubMed, Embase, Cochrane Library, Web of Science, and Scopus were searched on March 15, 2023. We selected cohort studies, case-control studies, and randomized controlled trials on the effect of MHT on AD in women. Odds ratio, relative risk, and hazard ratio were extracted. Random-effect models were used to estimate the polled estimates (relative risk [RR] or odds ratio [OR]) and their 95% confidence interval (95% CI). We included 3 randomized controlled trials, 12 cohort studies, and 16 case-control studies. A total of 7,710,379 women were included. Pooled estimates showed that MHT use for 3-5 years (cohort, RR = 0.56, 95% CI: 0.34-0.93) or initiation within 5 years of menopause (cohort, RR = 0.70, 95% CI: 0.49-0.99) reduced the risk of AD. Oral administration reduced AD risk (cohort, RR = 0.42, 95% CI: 0.40-0.44). Combining estrogen and progesterone (case-control, OR = 1.13, 95% CI: 1.05-1.21) or progesterone only (case-control, OR = 1.13, 95% CI: 1.10-1.17) increases AD risk. Tibolone increased AD risk (cohort, RR = 1.04, 95% CI: 1.01-1.07; case-control, OR = 1.07, 95% CI: 1.01-1.14). MHT-protected apolipoprotein E genotype 4 carriers (cohort, RR = 0.13, 95% CI: 0.02-0.90), depressed populations (cohort, RR = 0.85, 95% CI: 0.80-0.90), and Americas (cohort, RR = 0.54, 95% CI: 0.37-0.80; case-control, OR = 0.68, 95% CI: 0.47-0.99) from AD. Using MHT early (within 5 years after menopause) for about 5 years may protect against AD. However, combining estrogen with progesterone, or using progesterone only, could increase AD risk. Oral MHT methods are more effective than transdermal ones in reducing this risk. SIGNIFICANCE STATEMENT: Menopausal hormone therapy (MHT) use within 5 years after menopause could offer protective benefits against Alzheimer disease (AD). A combination of estrogen and progesterone, using progesterone only or tibolone usage was connected with an elevated risk of AD. Oral MHT was more effective than transdermal methods in lowering AD risk. MHT lowered AD risk in apolipoprotein E genotype 4 allele carriers, individuals with depression, and Americans. MHT regimens should be highly personalized.
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Affiliation(s)
- Qixiang Song
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qi Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; Center for Clinical Epidemiology and Evidence-Based Medicine, Shandong University, Jinan, China
| | - Dang Wu
- Institute of Health Sciences, China Medical University, Shenyang, China
| | - Zhe Zhang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Mengyao Chen
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chunying Fu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Meiling Li
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoyi Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yanqing Zhao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Dongshan Zhu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; Center for Clinical Epidemiology and Evidence-Based Medicine, Shandong University, Jinan, China.
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Pradhan A, Bhandari M, Vishwakarma P, Sethi R. Clopidogrel resistance and its relevance: Current concepts. J Family Med Prim Care 2024; 13:2187-2199. [PMID: 39027844 PMCID: PMC11254075 DOI: 10.4103/jfmpc.jfmpc_1473_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 07/20/2024] Open
Abstract
Clopidogrel is the most widely used P2Y12 receptor inhibitor (P2Y12i) as a part of dual antiplatelet therapy along with aspirin. Clopidogrel is a pro-drug and is metabolized to its active metabolite by the hepatic enzyme cytochrome P4502C19 (CYP2C19). This active metabolite is responsible for the antiplatelet action of clopidogrel. Recent studies have demonstrated that single nucleotide polymorphisms in the CYP2C19 gene, including CYP2C19*2,*3,*4, and *5 alleles, result in reduced production of the active metabolite of clopidogrel, and hence reduced inhibition of platelet aggregation. This in turn enhances the incidence of stent thrombosis and recurrent cardiovascular (CV) events. We report a case of coronary stent thrombosis due to clopidogrel resistance proven by CYP2C19 genotyping. We then review the literature on clopidogrel resistance and its impact on CV outcomes. Subsequently, we discuss the methods of diagnosis of resistance, evidence from clinical trials for tailoring clopidogrel therapy, the role of potent P2Y12 inhibitors, the current guidelines, and future directions.
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Affiliation(s)
- Akshyaya Pradhan
- Department of Cardiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Monika Bhandari
- Department of Cardiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Pravesh Vishwakarma
- Department of Cardiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Rishi Sethi
- Department of Cardiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
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Wu YJ, Wu CC, Huang HY, Wu CY, Huang CC, Wang CC. Low-dose prasugrel versus standard-dose ticagrelor in east Asian patients with acute coronary syndrome. J Thromb Thrombolysis 2024; 57:537-546. [PMID: 38555552 DOI: 10.1007/s11239-024-02965-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/02/2024]
Abstract
Low-dose prasugrel demonstrated a similar effectiveness profile to clopidogrel in East Asian ACS patients, but its comparison with another new-generation potent P2Y12 inhibitor, ticagrelor, remains unclear. To compare the effectiveness and safety of low-dose prasugrel against those of standard-dose ticagrelor in East Asian patients with ACS. This retrospective cohort study used Taiwan's National Health and Welfare Database. This study included ACS patients who underwent percutaneous coronary intervention and, at discharge between January 1, 2018 and December 31, 2020, were prescribed with low-dose prasugrel plus aspirin or standard-dose ticagrelor plus aspirin. Stabilized inverse probability of treatment weighting was used to balance the covariates across these two groups. The primary effectiveness outcome was a composite of acute myocardial infarction, ischemic stroke, and cardiovascular death; the secondary effectiveness outcome was each of the individual components of the primary outcome, transient ischemic attack, and repeat revascularization. The primary safety outcome was a composite of intracranial hemorrhage and gastrointestinal bleeding, and the two secondary safety outcomes were intracranial hemorrhage and gastrointestinal bleeding. A total of 24,807 patients were included in this study. Among them, 1,493 were low-dose prasugrel users and 23,314 were standard-dose ticagrelor users. No significant differences were found in primary effectiveness [HR: 0.97 (0.74-1.28)] or primary safety outcomes [HR: 1.22 (0.73-2.01)] between the two study groups. For East Asian patients with ACS, low-dose prasugrel provides comparable effectiveness without increasing bleeding risk compared to standard-dose ticagrelor. Low-dose prasugrel may be an appropriate alternative for East Asian populations.
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Affiliation(s)
- Yee-Jen Wu
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Chih Wu
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Room 203, No. 33 Linsen S. Rd., Zhongzheng Dist, Taipei, 10050, Taiwan
| | - Hsin-Yi Huang
- School of Pharmacy, College of Medicine, National Taiwan University, Room 203, No. 33 Linsen S. Rd., Zhongzheng Dist, Taipei, 10050, Taiwan
| | - Chi-Yun Wu
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Chang Huang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Chuan Wang
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
- School of Pharmacy, College of Medicine, National Taiwan University, Room 203, No. 33 Linsen S. Rd., Zhongzheng Dist, Taipei, 10050, Taiwan.
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Room 203, No. 33 Linsen S. Rd., Zhongzheng Dist, Taipei, 10050, Taiwan.
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Blaško P, Samoš M, Bolek T, Stančiaková L, Škorňová I, Péč MJ, Jurica J, Staško J, Mokáň M. Resistance on the Latest Oral and Intravenous P2Y12 ADP Receptor Blockers in Patients with Acute Coronary Syndromes: Fact or Myth? J Clin Med 2022; 11:jcm11237211. [PMID: 36498785 PMCID: PMC9737839 DOI: 10.3390/jcm11237211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/12/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Novel P2Y12 ADP receptor blockers (ADPRB) should be preferred in dual-antiplatelet therapy in patients with acute coronary syndrome. Nevertheless, there are still patients who do not respond optimally to novel ADP receptor blocker therapy, and this nonoptimal response (so-called "high on-treatment platelet reactivity" or "resistance") could be connected with increased risk of adverse ischemic events, such as myocardial re-infarction, target lesion failure and stent thrombosis. In addition, several risk factors have been proposed as factors associated with the phenomenon of inadequate response on novel ADPRB. These include obesity, multivessel coronary artery disease, high pre-treatment platelet reactivity and impaired metabolic status for prasugrel, as well as elderly, concomitant therapy with beta-blockers, morphine and platelet count for ticagrelor. There is no literature report describing nonoptimal therapeutic response on cangrelor, and cangrelor therapy seems to be a possible approach for overcoming HTPR on prasugrel and ticagrelor. However, the optimal therapeutic management of "resistance" on novel ADPRB is not clear and this issue requires further research. This narrative review article discusses the phenomenon of high on-treatment platelet reactivity on novel ADPRB, its importance in clinical practice and approaches for its therapeutic overcoming.
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Affiliation(s)
- Peter Blaško
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
- Out-Patient Clinic of Cardiology, 957 01 Banovce nad Bebravou, Slovakia
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
- Correspondence: ; Tel.: +421-907-612-943 or +421-434-203-820
| | - Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Lucia Stančiaková
- Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Ingrid Škorňová
- Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Martin Jozef Péč
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Jakub Jurica
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Ján Staško
- Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
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