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Mancusi C, Basile C, Fucile I, Palombo C, Lembo M, Buso G, Agabiti-Rosei C, Visco V, Gigante A, Tocci G, Maloberti A, Tognola C, Pucci G, Curcio R, Cicco S, Piani F, Marozzi MS, Milan A, Leone D, Cogliati C, Schiavon R, Salvetti M, Ciccarelli M, De Luca N, Volpe M, Muiesan ML. Aortic Remodeling in Patients with Arterial Hypertension: Pathophysiological Mechanisms, Therapeutic Interventions and Preventive Strategies-A Position Paper from the Heart and Hypertension Working Group of the Italian Society of Hypertension. High Blood Press Cardiovasc Prev 2025; 32:255-273. [PMID: 40082374 PMCID: PMC12098454 DOI: 10.1007/s40292-025-00710-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 02/18/2025] [Indexed: 03/16/2025] Open
Abstract
In patient with arterial hypertension the whole aorta is exposed to increased wall stress due to pressure overload. Different blood pressure (BP) components have been reported as main determinant of aortic remodelling. In particular increased diastolic BP has been associated with aortic dilatation across all its segments with smaller increase in aortic root and ascending aorta related to increased systolic BP and pulse pressure. Optimal BP control is crucial to prevent development of aortic aneurysm and acute aortic disease. Many studies have evaluated the role of different antihypertensive drug classes for prevention of adverse aortic remodelling including beneficial effects of ACEIs, ARBs, dihydropyridinic calcium channel blockers and Beta-blockers. The present review discusses pathophysiological mechanisms, therapeutic interventions and preventive strategies for development of aortic remodeling in patients with arterial hypertension.
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Affiliation(s)
- Costantino Mancusi
- Department of Advanced Biomedical Science, Hypertension Research Center, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
| | - Christian Basile
- Department of Advanced Biomedical Science, Hypertension Research Center, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Ilaria Fucile
- Department of Advanced Biomedical Science, Hypertension Research Center, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Carlo Palombo
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Science, Hypertension Research Center, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Giacomo Buso
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Division of Internal Medicine, ASST Spedali Civili Brescia, Brescia, Italy
- Centro per lo Studio dell'Ipertensione Arteriosa e Fattori di Rischio Cardiovascolari, Brescia, Italy
| | - Claudia Agabiti-Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Division of Internal Medicine, ASST Spedali Civili Brescia, Brescia, Italy
- Centro per lo Studio dell'Ipertensione Arteriosa e Fattori di Rischio Cardiovascolari, Brescia, Italy
| | - Valeria Visco
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Via Salvador Allende, 84081, Baronissi, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Alessandro Maloberti
- School of Medicine and surgery, University of Milano-Bicocca, Milan, Italy
- Cardiology 4, "A.De Gasperis" Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy
| | - Chiara Tognola
- School of Medicine and surgery, University of Milano-Bicocca, Milan, Italy
- Cardiology 4, "A.De Gasperis" Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy
| | - Giacomo Pucci
- Unit of Internal and Traslational Medicine, Terni University Hospital, Terni, Italy
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Rosa Curcio
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Sebastiano Cicco
- Unit of Internal Medicine "Guido Baccelli" and Unit of Hypertension "Anna Maria Pirrelli", Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari Aldo Moro, AUOC Policlinico di Bari, Bari, Italy
| | - Federica Piani
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40138, Bologna, Italy
| | - Marialuisa Sveva Marozzi
- Unit of Internal Medicine "Guido Baccelli" and Unit of Hypertension "Anna Maria Pirrelli", Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari Aldo Moro, AUOC Policlinico di Bari, Bari, Italy
| | - Alberto Milan
- Division of Internal Medicine, Candiolo Cancer Institute FPO- IRCCS, Candiolo, TO, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Dario Leone
- Division of Internal Medicine, Candiolo Cancer Institute FPO- IRCCS, Candiolo, TO, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Chiara Cogliati
- Department of Biomedical and Clinical Sciences, University of Milan and Internal Medicine, L.Sacco Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Riccardo Schiavon
- Internal Medicine, L.Sacco Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia & ASST Spedali Civili di Brescia, Brescia, Italy
| | - Michele Ciccarelli
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Via Salvador Allende, 84081, Baronissi, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Science, Hypertension Research Center, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy
| | | | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Division of Internal Medicine, ASST Spedali Civili Brescia, Brescia, Italy
- Centro per lo Studio dell'Ipertensione Arteriosa e Fattori di Rischio Cardiovascolari, Brescia, Italy
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Via Salvador Allende, 84081, Baronissi, Italy
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Wesley CD, Strange JE, Holt A, Gislason GH, Neutel CHG, Krüger DN, Civati C, Theunis M, Naessens T, Roth L, De Meyer GRY, Martinet W, Rasmussen PV, Guns PJ. Fluoroquinolones and the risk of aortic aneurysm or aortic dissection: evidence from a nationwide nested case-control study paralleled with matched experimental models. EUROPEAN HEART JOURNAL OPEN 2025; 5:oeaf021. [PMID: 40352252 PMCID: PMC12062879 DOI: 10.1093/ehjopen/oeaf021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 12/20/2024] [Accepted: 01/31/2025] [Indexed: 05/14/2025]
Abstract
Aims Fluoroquinolones (FQ) have been associated with aortic aneurysm and aortic dissection (AA/AD) resulting in an official warning. Recently, large-scale epidemiological studies failed to confirm this. Methods and Results The current study aimed to scrutinize the FQ-AA/AD association through a retrospective nested case-cohort analysis supplemented with animal experimentation. FQ exposure was not associated with increased AA/AD hazard ratios in main and high-risk (elderly ≥65 years, hypertensive, and prevalent aortic disease) populations. Additionally, FQ did not cause increased mortality or aortic interventions in aortic disease patients. In addition, in animal experimentation, ciprofloxacin did not enlarge aortic diameters nor increase arterial stiffness. Conclusion Conventional use of FQ should not be avoided when clinically indicated.
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Affiliation(s)
- Callan D Wesley
- Laboratory of Physiopharmacology, Faculty of Medicine and Health Sciences and Faculty of Pharmaceutical Biomedical and Veterinary Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
| | - Jarl Emanuel Strange
- Department of Cardiology, Copenhagen University Hospital–Herlev and Gentofte, Gentofte Hospitalsvej 6, Hellerup 2900, Denmark
| | - Anders Holt
- Department of Cardiology, Copenhagen University Hospital–Herlev and Gentofte, Gentofte Hospitalsvej 6, Hellerup 2900, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital–Herlev and Gentofte, Gentofte Hospitalsvej 6, Hellerup 2900, Denmark
| | - Cédric H G Neutel
- Laboratory of Physiopharmacology, Faculty of Medicine and Health Sciences and Faculty of Pharmaceutical Biomedical and Veterinary Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
| | - Dustin N Krüger
- Laboratory of Physiopharmacology, Faculty of Medicine and Health Sciences and Faculty of Pharmaceutical Biomedical and Veterinary Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
| | - Celine Civati
- Laboratory of Physiopharmacology, Faculty of Medicine and Health Sciences and Faculty of Pharmaceutical Biomedical and Veterinary Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
| | - Mart Theunis
- Laboratory of Natural Products & Food Research and Analysis-Pharmaceutical Technology (NatuRAPT), Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
| | - Tania Naessens
- Laboratory of Natural Products & Food Research and Analysis-Pharmaceutical Technology (NatuRAPT), Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
| | - Lynn Roth
- Laboratory of Physiopharmacology, Faculty of Medicine and Health Sciences and Faculty of Pharmaceutical Biomedical and Veterinary Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
| | - Guido R Y De Meyer
- Laboratory of Physiopharmacology, Faculty of Medicine and Health Sciences and Faculty of Pharmaceutical Biomedical and Veterinary Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
| | - Wim Martinet
- Laboratory of Physiopharmacology, Faculty of Medicine and Health Sciences and Faculty of Pharmaceutical Biomedical and Veterinary Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
| | - Peter Vibe Rasmussen
- Department of Cardiology, Copenhagen University Hospital–Herlev and Gentofte, Gentofte Hospitalsvej 6, Hellerup 2900, Denmark
| | - Pieter-Jan Guns
- Laboratory of Physiopharmacology, Faculty of Medicine and Health Sciences and Faculty of Pharmaceutical Biomedical and Veterinary Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
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3
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Rizk JG, Slejko JF, Heil EL, Seo D, Qato DM. Impact of the US Food and Drug Administration warning regarding increased risk of aortic aneurysms or aortic dissections on fluoroquinolone prescribing trends. BMJ Open Qual 2024; 13:e002925. [PMID: 39053916 PMCID: PMC11733791 DOI: 10.1136/bmjoq-2024-002925] [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: 05/25/2024] [Accepted: 07/06/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The US Food and Drug Administration (FDA) issued a warning in December 2018 regarding an increased risk of aortic aneurysms and aortic dissections associated with fluoroquinolone (FQ) use. This warning specifically targeted older adults and patients with conditions such as hypertension, Marfan syndrome, Ehlers-Danlos syndrome, atherosclerosis, peripheral vascular disease and history of aneurysms. OBJECTIVE To evaluate the impact of the safety warning on prescribing trends of FQs in the targeted population. METHODS This cross-sectional study with an interrupted time series (ITS) analysis (January 2018-December 2019) used a 25% random sample of IQVIA PharMetrics® Plus for Academics health plan claims database. The impact of the warning on FQ utilisation was quantified among the targeted population and a non-targeted population. RESULTS From 2018 to 2019, both study populations saw a decrease in the year-over-year percent change of FQ prescriptions per 100 000 beneficiaries (-11%, from 14 227 to 12 662, targeted; -15%, from 5227 to 4446, non-targeted) and proportion of FQ use versus other antibiotics (from 15.6% to 13.8%, targeted; from 9.4% to 8%, non-targeted). In the targeted population, the ITS analysis did not show a significant trend change, a change in level or postwarning trend in the monthly rate of FQ prescriptions per 1000 beneficiaries. A positive trend change was observed in the non-targeted population (0.07, <0.01-0.13), but there were no significant changes in level or post-warning trend. CONCLUSION We did not find a change in FQ prescription rates after the warning. The utility of safety advisories as a primary tool for mitigating FQ use in high-risk populations should be revisited.
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Affiliation(s)
- John G Rizk
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Julia F Slejko
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Emily L Heil
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Dominique Seo
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Danya M Qato
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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4
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Barberán J, de la Cuerda A, Tejeda González MI, López Aparicio A, Monfort Vinuesa C, Ramos Sánchez A, Barberán LC. Safety of fluoroquinolones. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2024; 37:127-133. [PMID: 38140798 PMCID: PMC10945095 DOI: 10.37201/req/143.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 06/01/2023]
Abstract
Fluoroquinolones (FQs) are one of the most commonly prescribed classes of antibiotics. Although they were initially well tolerated in randomized clinical trials, subsequent epidemiological studies have reported an increased risk of threatening, severe, long-lasting, disabling and irreversible adverse effects (AEs), related to neurotoxicity and collagen degradation, such as tendonitis, Achilles tendon rupture, aortic aneurysm, and retinal detachment. This article reviews the main potentially threatening AEs, the alarms issued by regulatory agencies and therapeutic alternatives.
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Affiliation(s)
- J Barberán
- José Barberán, Hospital Universitario HM Montepríncipe, Facultad HM Hospitales de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, Spain.
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5
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Banceu CM, Banceu DM, Kauvar DS, Popentiu A, Voth V, Liebrich M, Halic Neamtu M, Oprean M, Cristutiu D, Harpa M, Brinzaniuc K, Suciu H. Acute Aortic Syndromes from Diagnosis to Treatment-A Comprehensive Review. J Clin Med 2024; 13:1231. [PMID: 38592069 PMCID: PMC10932437 DOI: 10.3390/jcm13051231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
This work aims to provide a comprehensive description of the characteristics of a group of acute aortic diseases that are all potentially life-threatening and are collectively referred to as acute aortic syndromes (AASs). There have been recent developments in the care and diagnostic plan for AAS. A substantial clinical index of suspicion is required to identify AASs before irreversible fatal consequences arise because of their indefinite symptoms and physical indicators. A methodical approach to the diagnosis of AAS is addressed. Timely and suitable therapy should be started immediately after diagnosis. Improving clinical outcomes requires centralising patients with AAS in high-volume centres with high-volume surgeons. Consequently, the management of these patients benefits from the increased use of aortic centres, multidisciplinary teams and an "aorta code". Each acute aortic entity requires a different patient treatment strategy; these are outlined below. Finally, numerous preventive strategies for AAS are discussed. The keys to good results are early diagnosis, understanding the natural history of these disorders and, where necessary, prompt surgical intervention. It is important to keep in mind that chest pain does not necessarily correspond with coronary heart disease and to be alert to the possible existence of aortic diseases because once antiplatelet drugs are administered, a blocked coagulation system can complicate aortic surgery and affect prognosis. The management of AAS in "aortic centres" improves long-term outcomes and decreases mortality rates.
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Affiliation(s)
- Cosmin M. Banceu
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania; (C.M.B.)
- Department of Surgery M3, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Targu Mures, Romania
| | - Diana M. Banceu
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Targu Mures, Romania
| | - David S. Kauvar
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Adrian Popentiu
- Faculty of Medicine, University Lucian Blaga Sibiu, 550169 Sibiu, Romania
| | | | | | - Marius Halic Neamtu
- Swiss Federal Institute of Forest, Snow and Landscape Research WSL, 8903 Birmensdorf, Switzerland
- Institute of Environmental Engineering, ETH Zurich, 8039 Zurich, Switzerland
| | - Marvin Oprean
- Mathematics and Statistics Department, Amherst College, Amherst, MA 01002, USA
| | - Daiana Cristutiu
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Targu Mures, Romania
| | - Marius Harpa
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania; (C.M.B.)
- Department of Surgery M3, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Targu Mures, Romania
| | - Klara Brinzaniuc
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania; (C.M.B.)
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Horatiu Suciu
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania; (C.M.B.)
- Department of Surgery M3, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Targu Mures, Romania
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6
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Patel N, Gorseth A, Belfiore G, Stornelli N, Lowry C, Thomas L. Fluoroquinolone-associated adverse events of interest among hospitalized veterans affairs patients with community-acquired pneumonia who were treated with a fluoroquinolone: A focus on tendonitis, Clostridioides difficile infection, and aortic aneurysm. Pharmacotherapy 2024; 44:49-60. [PMID: 37699580 DOI: 10.1002/phar.2877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 09/14/2023]
Abstract
STUDY OBJECTIVE The objectives of this study were to (i) quantify the incidence of three concerning fluoroquinolone adverse events of interest (FQAEI, i.e., adverse tendon event (TE), clostridioides difficile infection (CDI), and aortic aneurysm/dissection (AAD)), (ii) identify the patient-level factors that predict these events, and (iii) develop clinical risk scores to estimate the predicted probabilities of each FQAEI based on patient-level covariates available on clinical presentation. DESIGN Retrospective cohort study. SETTING Upstate New York Veterans' Healthcare Administration from 2011 to 2016. PATIENTS Hospitalized patients with community-acquired pneumonia receiving care in the Upstate New York Veterans' Healthcare Administration from 2011 to 2016. INTERVENTION N/A. MEASUREMENTS The outcomes of interest for this study were the occurrence of TE, CDI, and AAD. We also evaluated a composite of these three outcomes, FQAEI. MAIN RESULTS The study population consisted of 1071 patients. The overall incidence of FQAEI, TE, AAD, and CDI was 6.5%, 1.8%, 4.5%, and 0.3%, respectively. For each outcome evaluated, the probability of the event of interest was predicted by the presence of certain comorbidities, previous healthcare exposure, choice of specific FQ antibiotic, or therapy duration. Concomitant steroids, pneumonia in preceding 180 days, and creatinine clearance <30 mL/min predicted FQAEI. CONCLUSIONS Individual frequencies of three important FQAEIs were quantified, and risk scores were developed to estimate the probabilities of experiencing these events to help clinicians individualize treatment decisions for patients and reduce the potential risks of select FQAEIs.
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Affiliation(s)
- Nimish Patel
- Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California San Diego, La Jolla, California, USA
- Samuel S. Stratton Veteran's Affairs Medical Center, Albany, New York, USA
| | - Allison Gorseth
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA
- Department of Pharmacy, Hartford Hospital, Hartford, Connecticut, USA
| | - Gina Belfiore
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | - Nicholas Stornelli
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA
- Department of Pharmacy Services, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, USA
| | - Colleen Lowry
- Samuel S. Stratton Veteran's Affairs Medical Center, Albany, New York, USA
| | - Lodise Thomas
- Samuel S. Stratton Veteran's Affairs Medical Center, Albany, New York, USA
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA
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7
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Xuan X, Li Y, Cao G, Zhang R, Hu J, Jin H, Dong H. Fluoroquinolones increase susceptibility to aortic aneurysm and aortic dissection: Molecular mechanism and clinical evidence. Vasc Med 2023; 28:604-613. [PMID: 37756313 DOI: 10.1177/1358863x231198055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Aortic aneurysm (AA) and aortic dissection (AD) are prevalent severe cardiovascular diseases that result in catastrophic complications and unexpected deaths. Owing to the lack of clinically established and effective medications, the only treatment options are open surgical repair or endovascular therapy. Most researchers have focused on the development of innovative medications or therapeutic targets to slow the progression of AA/AD or lower the risk of malignant consequences. Recent studies have shown that the use of fluoroquinolones (FQs) may increase susceptibility to AA/AD to some extent, especially in patients with aortic dilatation and those at a high risk of AD. Therefore, it is crucial for doctors, particularly those in cardiovascular specialties, to recognize the dangers of FQs and adopt alternatives. In the present review, the main clinical observational studies on the correlation between FQs and AA/AD in recent years are summarized, with an emphasis on the relative physiopathological mechanism incorporating destruction of the extracellular matrix (ECM), phenotypic transformation of vascular smooth muscle cells, and local inflammation. Although additional data are required, it is anticipated that the rational use of FQs will become the standard of care for the treatment of aortic diseases.
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Affiliation(s)
- Xuezhen Xuan
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yaling Li
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Genmao Cao
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Ruijing Zhang
- Department of Nephrology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jie Hu
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Haijiang Jin
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Honglin Dong
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
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