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Pozzi A, Cirelli C, Merlo A, Rea F, Scangiuzzi C, Tavano E, Iorio A, Kristensen SL, Wong C, Iacovoni A, Corrado G. Adverse effects of sodium-glucose cotransporter-2 inhibitors in patients with heart failure: a systematic review and meta-analysis. Heart Fail Rev 2024; 29:207-217. [PMID: 37917192 DOI: 10.1007/s10741-023-10363-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
Sodium-glucose cotransoporter-2 inhibitors (SGLT-2Is) improve prognosis in heart failure (HF) patients both with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). However, these drugs can have some side effects. To estimate the relative risk of side effects in HF patients treated with SGLT-2Is irrespective from left ventricular EF and setting (chronic and non-chronic HF). Five randomized controlled trials (RCTs) enrolling patients with HFrEF, 4 RCTs enrolling non-chronic HF, and 3 RCTs enrolling HFpEF were included. Among side effects, urinary infection, genital infection, acute kidney injury, diabetic ketoacidosis, hypoglycemia, hyperkalemia, hypokalemia, bone fractures, and amputations were considered in the analysis. Overall, 24,055 patients were included in the analysis: 9020 (38%) patients with HFrEF, 12,562 (52%) with HFpEF, and 2473 (10%) with non-chronic HF. There were no differences between SGLT-2Is and placebo in the risk to develop diabetic ketoacidosis, hypoglycemia, hyperkalemia, hypokalemia, bone fractures, and amputations. HFrEF patients treated with SGLT-2Is had a significant reduction of acute kidney injury (RR = 0.54 (95% CI 0.33-0.87), p = 0.011), whereas no differences have been reported in the HFpEF group (RR = 0.94 (95% CI 0.83-1.07), p = 0.348) and non-chronic HF setting (RR = 0.79 (95% CI 0.55-1.15), p = 0.214). A higher risk to develop genital infection (overall 2.57 (95% CI 1.82-3.63), p < 0.001) was found among patients treated with SGLT-2Is irrespective from EF (HFrEF: RR = 1.96 (95% CI 1.17-3.29), p = 0.011; HFpEF: RR = 3.04 (95% CI 1.88-4.90), p < 0.001). The risk to develop urinary infections was increased among SGLT-2I users in the overall population (RR = 1.13 (95% CI 1.00-1.28), p = 0.046) and in the HFpEF setting (RR = 1.19 (95% CI 1.02-1.38), p = 0.029), whereas no differences have been reported in HFrEF (RR = 1.05 (95% CI 0.81-1.36), p = 0.725) and in non-chronic HF setting (RR = 1.04 (95% CI 0.75-1.46), p = 0.806). SGLT-2Is increase the risk of urinary and genital infections in HF patients. In HFpEF patients, the treatment increases the risk of urinary infections compared to placebo, whereas SGLT-2Is reduce the risk of acute kidney disease in patients with HFrEF.
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Affiliation(s)
- A Pozzi
- Cardiology Division, Valduce Hospital, Como, Italy.
| | - C Cirelli
- Cardiology Division, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Milano-Bicocca University, Milan, Italy
| | - A Merlo
- Cardiology Division, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Milano-Bicocca University, Milan, Italy
| | - F Rea
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - C Scangiuzzi
- Cardiology Division, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Milano-Bicocca University, Milan, Italy
| | - E Tavano
- Cardiology Division, Circolo Hospital, Busto Arsizio, Italy
| | - A Iorio
- Cardiology Division, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - S L Kristensen
- Cardiology Division, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - C Wong
- Cardiology Division, North Bristol, Bristol, UK
| | - A Iacovoni
- Cardiology Division, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - G Corrado
- Cardiology Division, Valduce Hospital, Como, Italy
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Pozzi A, Cirelli C, Merlo A, Rea F, Scangiuzzi C, Tavano E, Iorio A, Kristensen SL, Wong C, Iacovoni A, Corrado G. Correction to: Adverse effects of sodium‑glucose cotransporter‑2 inhibitors in patients with heart failure: a systematic review and meta‑analysis. Heart Fail Rev 2024; 29:303. [PMID: 38072892 DOI: 10.1007/s10741-023-10378-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 03/01/2024]
Affiliation(s)
- A Pozzi
- Cardiology Division, Valduce Hospital, Como, Italy.
| | - C Cirelli
- Cardiology Division, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Milano-Bicocca University, Milan, Italy
| | - A Merlo
- Cardiology Division, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Milano-Bicocca University, Milan, Italy
| | - F Rea
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - C Scangiuzzi
- Cardiology Division, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Milano-Bicocca University, Milan, Italy
| | - E Tavano
- Cardiology Division, Circolo Hospital, Busto Arsizio, Italy
| | - A Iorio
- Cardiology Division, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - S L Kristensen
- Cardiology Division, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - C Wong
- Cardiology Division, North Bristol, Bristol, UK
| | - A Iacovoni
- Cardiology Division, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - G Corrado
- Cardiology Division, Valduce Hospital, Como, Italy
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3
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Pozzi A, Abete R, Tavano E, Kristensen SL, Rea F, Iorio A, Iacovoni A, Corrado G, Wong C. Sacubitril/valsartan and arrhythmic burden in patients with heart failure and reduced ejection fraction: a systematic review and meta-analysis. Heart Fail Rev 2023; 28:1395-1403. [PMID: 37380925 DOI: 10.1007/s10741-023-10326-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/30/2023]
Abstract
The aim of this study was to assess whether angiotensin receptor/neprilysin inhibitor (ARNI) decreases ventricular arrhythmic burden compared to angiotensin-converting enzyme inhibitors or angiotensin receptor antagonist (ACE-I/ARB) treatment in chronic heart failure with reduced ejection fraction (HFrEF) patients. Further, we assessed if ARNI influenced the percentage of biventricular pacing. A systematic review of studies (both RCTs and observational studies) including HFrEF patients and those receiving ARNI after ACE-I/ARB treatment was conducted using Medline and Embase up to February 2023. Initial search found 617 articles. After duplicate removal and text check, 1 RCT and 3 non-RCTs with a total of 8837 patients were included in the final analysis. ARNI was associated with a significative reduction of ventricular arrhythmias both in RCT (RR 0.78 (95% CI 0.63-0.96); p = 0.02) and observational studies (RR 0.62; 95% CI 0.53-0.72; p < 0.001). Furthermore, in non-RCTs, ARNI also reduced sustained (RR 0.36 (95% CI 0.2-0.63); p < 0.001), non-sustained VT (RR 0.67 (95% CI 0.57-0.80; p = 0.007), ICD shock (RR 0.24 (95% CI 0.12-0.48; p < 0.001), and increased biventricular pacing (2.96% (95% CI 2.25-3.67), p < 0.001). In patients with chronic HFrEF, switching from ACE-I/ARB to ARNI treatment was associated with a consistent reduction of ventricular arrhythmic burden. This association could be related to a direct pharmacological effect of ARNI on cardiac remodeling.Trial registration: CRD42021257977.
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Affiliation(s)
- A Pozzi
- Cardiology Department, Valduce Hospital, Como, Italy.
| | - R Abete
- Cardiology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - E Tavano
- Ospedale di Circolo Busto Arsizio, Busto Arsizio, Italy
| | - S L Kristensen
- Cardiology Department, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - F Rea
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - A Iorio
- Cardiology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A Iacovoni
- Cardiology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - G Corrado
- Cardiology Department, Valduce Hospital, Como, Italy
| | - C Wong
- Cardiology Department, Southmead Hospital, Bristol, UK
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Stahl A, Havers-Borgersen E, Oestergaard L, Petersen JK, Bruun NE, Weeke PE, Kristensen SL, Voldstedlund M, Koeber L, Fosboel EL. Association between hemodialysis and patient characteristics, microbiological etiology, cardiac surgery, and mortality in patients with infective endocarditis: a nationwide study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Hemodialysis and infective endocarditis are both associated with poor patient outcome. However, despite high mortality rates for each disease entity, little attention is given to patients on hemodialysis who develop infective endocarditis.
Purpose
To examine patient characteristics, microbiological etiology, cardiac surgery, and outcome among patients on hemodialysis with infective endocarditis compared with patients with infective endocarditis without hemodialysis treatment.
Methods
With Danish nationwide registries, we identified patients with infective endocarditis between 2010–2018 and linked them to microbiological data from a nationwide microbiological registry with complete blood culture data. We included patients in the hemodialysis group if they received hemodialysis treatment within 6 months prior to their first-time infective endocarditis admission. Patients not meeting this criteria were put in the non-hemodialysis group. We used Kaplan-Meier estimates for difference in mortality and Cox regression for adjusted analysis.
Results
We included 4,106 patients with infective endocarditis of which 265 (6.5%) patients were also in hemodialysis treatment (66.8% men). Patients on hemodialysis were younger (median age 66 years [IQR=54.2–74.9] vs. 72.3 years [IQR=62.3–80.4]) and had a higher burden of comorbidities including hypertension (68.7 vs. 56.9%), diabetes (47.2% vs. 18.8%), and ischemic heart disease (41.1% vs. 32.2%) compared to patients without hemodialysis treatment, all p-values <0.01. Cardiac surgery was less frequently performed in patients in the hemodialysis group than in the non-hemodialysis group (11.9% vs. 19.4%, respectively, p<0.001) and Staphylococcus aureus was more frequently the microbiological etiology of infective endocarditis in the hemodialysis group than in the non-hemodialysis group (57.0% vs. 25.3%, respectively, p<0.0001). No statistically significant difference for in-hospital mortality was found. Figure 1 shows difference in mortality between the two groups. 1- and 5-year mortality were significantly higher in the hemodialysis group than in the non-hemodialysis group (34.3% vs. 17.2% and 50.5% vs. 33.9%, respectively, p<0.00001) and in adjusted analysis hemodialysis was associated with higher 1- and 5-year mortality (hazard ratio of 2.41, 95% CI 1.85–3.13 and 2.50, 95% CI 2.05–3.05, respectively), as compared with patients in the non-hemodialysis group.
Conclusion
Patients on hemodialysis with infective endocarditis are younger, sicker and have Staphylococcus aureus as causing agent more than twice as often as patients with infective endocarditis without hemodialysis treatment. This patient group have a higher mortality and by 5 years, 75% of patients in our hemodialysis group were dead.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Stahl
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | - E Havers-Borgersen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | - L Oestergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | - J K Petersen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | - N E Bruun
- Zealand University Hospital, Department of Cardiology , Roskilde , Denmark
| | - P E Weeke
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | - S L Kristensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | | | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | - E L Fosboel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
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Dam Lauridsen M, Rorth R, Butt JH, Schmidt M, Kristensen SL, Kragholm K, Johnsen SP, Moller JE, Hassager C, Kober LV, Fosbol EL. Home care provision and nursing home admission after myocardial infarction in relation to cardiogenic shock and out-of-hospital cardiac arrest status. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Autonomy is of great importance for quality of life. There is a paucity of data on autonomy for those who survive myocardial infarction (MI) with and without cardiogenic shock (CS) and out-of-hospital arrest (OHCA).
Purpose
To examine the association between CS, OHCA, and need for home care provision or nursing home admission as a proxy for impaired autonomy in a first-time MI population.
Methods
Danish nationwide registries were used to identify patients with first-time MI (2009–2019), who prior to the event were living at home without home care and discharged alive. The patients were stratified according to CS and OHCA status. We report 1-year cumulative incidence of a composite outcome of home care provision or nursing home admission with competing risk of death and as a secondary outcome all-cause mortality. Cause specific Cox regression models were used to estimate adjusted hazard ratios (HR) with patients without CS or OHCA as reference.
Results
We identified 61,451 patients in the period with MI (by groups: −OHCA/−CS: 59,316, −OHCA/+CS: 1,597, +OHCA/−CS: 913, and +OHCA/+CS: 669). The 1-year cumulative incidences of home care/nursing home were 6.9% for patients with −OHCA/−CS, 21.1% for −OHCA/+CS, 5.2% for +OHCA/−CS, and 8.1% for those with +OHCA/+CS. With the −OHCA/−CS as reference, the adjusted HRs for home care/nursing home were 3.12 (95% CI: 2.78–3.49) for patients with −OHCA/+CS, 1.27 (95% CI: 0.95–1.70) for +OHCA/−CS, and 2.31 (95% CI: 1.76–3.03) for +OHCA/+CS (Figure). The 1-year cumulative incidences of mortality were 4.8% for patients with −OHCA/−CS, 10.0% for −OHCA/+CS, 2.8% for +OHCA/−CS, and 3.7% for those with +OHCA/+CS (adjusted HRs: 2.81 (95% CI: 2.55–3.10), 1.09 (95% CI: 0.85–1.39) and 1.81 (95% CI: 1.42–2.30) (Figure 1).
Conclusion
In a selected cohort of patients with MI, without previous need for home care/nursing home and surviving until discharge date, patients with CS were independent of OHCA status associated with less autonomy after discharge with a more than two-fold higher 1-year incidence of home care provision or nursing home admission. Further, patients with CS were associated with a two-fold higher 1-year mortality compared with MI patients without CS independent of OHCA status.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): The work was supported by Rigshospitalets Research Foundation, Master cabinetmaker Sophus Jacobsen and Wife Astrid Jacobsen Foundation, and Director Jacob Madsen and Wife Olga Madsens Foundation. The funding source had no role in the design, conduct, analysis, or reporting of the study.
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Affiliation(s)
- M Dam Lauridsen
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - R Rorth
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J H Butt
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - M Schmidt
- Aarhus University Hospital, Department of Clinical Epidemiology , Aarhus , Denmark
| | - S L Kristensen
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - K Kragholm
- Aalborg University Hospital, Department of Cardiology , Aalborg , Denmark
| | - S P Johnsen
- Aalborg University, Danish Center for Clinical Health Services Research, Department of Clinical Medicine , Aalborg , Denmark
| | - J E Moller
- Odense University Hospital , Odense , Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - L V Kober
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - E L Fosbol
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
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Westergaard L, Joens C, Kroell J, Kristensen SL, Johannessen A, Sandgaard N, Gang UJO, Hansen PS, Riahi S, Kristiansen SB, Fosboel EL, Pehrson S, Chen X, Jacobsen PK, Weeke PE. Heart failure hospitalizations and diuretic use before and after first-time pulmonary vein isolation ablation for atrial fibrillation among patients with heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Small randomized clinical trials have found that patients with heart failure (HF) and atrial fibrillation (AF) randomized to an ablation strategy for AF experienced improved cardiovascular outcomes. We examined the relation in routine clinical practice.
Purpose
We aimed to assess if first-time pulmonary vein isolation ablation (PVI) for AF among patients with HF was associated with decrease in HF hospital admissions rates and furosemide dosage in the year after PVI compared with the year before.
Methods
We identified patients with HF and available left ventricular ejection fraction (LVEF) treated with a first-time PVI using the Danish Ablation Registry, and alive at 1-year follow-up. Patient comorbidities and concomitant pharmacotherapy (including furosemide dosage and HF hospital admissions) were identified utilizing Danish nationwide registries. For inclusion, patients were required to have been diagnosed with HF in an in- or outpatient setting <10 years of first-time PVI or have a LVEF at the time of PVI ≤45%. Patients were grouped according to LVEF at time of PVI: ≤35%, 36–45%, and >45%. For comparison of HF hospital admission and furosemide usage before and after PVI, McNemars test were used. Wilcox signed-rank test were used to test difference in furosemide dosage before and after PVI.
Results
We identified 668/3450 patients with HF treated with first-time PVI for AF between 2010–2017 (median age 62 years [Q1,Q3=56,69 years], 81% male, and median LVEF 45% [Q1,Q3=40,60%]). Of these, 13 patients (2%) died during one-year follow-up. Overall, 36% of patients with HF had one or more HF hospital admissions the year before PVI compared with 7% in the year after PVI (p<0.0001) (Figure 1). Patients with LVEF ≤35% had the highest proportion of HF hospital admissions the year before PVI (53%) and was reduced more than 4-fold (13%) in the year after first-time PVI, with consistent findings in all LVEF groups (Figure 1). At the time of PVI, 36% of patients with HF were treated with furosemide compared with 30% in the year after PVI (p<0.0001) (Figure 2). Moreover, we identified significant reductions in furosemide dose in the year after PVI compared with the year before (median dose 60 mg [Q1,Q3=30,80 mg] and 20 mg [Q1,Q3=0,60 mg], respectively, p=0.001). Here, reductions in furosemide requirements were consistent across LVEF subgroups.
Conclusion
Patients with HF treated with a first-time PVI strategy for AF had a 5-fold decrease in HF hospital admissions in the following year compared with the year before PVI. Among patients treated with furosemide at time of PVI, significant reductions in dose one year after PVI was identified but also significant reductions in proportion of patients requiring any furosemide at all.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Westergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | - C Joens
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | - J Kroell
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | - S L Kristensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | - A Johannessen
- Gentofte University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - N Sandgaard
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - U J O Gang
- Zealand University Hospital, Department of Cardiology , Roskilde , Denmark
| | | | - S Riahi
- Aalborg University Hospital, Department of Cardiology , Aalborg , Denmark
| | - S B Kristiansen
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - E L Fosboel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | - S Pehrson
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | - X Chen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | - P K Jacobsen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
| | - P E Weeke
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre , Copenhagen , Denmark
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Begun X, Butt JH, Kristensen SL, Weeke PE, Backer OD, Schou M, Kober L, Fosboel EL. Diuretic use before and after transcatheter aortic valve implantation: a nationwide study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Transcatheter aortic valve implantation (TAVI) is the new standard of care in patients of older age with symptomatic severe aortic stenosis, and these patients often depend upon diuretics for symptom relief. Randomized clinical trials suggest that approximately one third of patients undergoing TAVI do not achieve symptom relief. Furthermore, some patients have more symptoms after intervention, but “real-life” data are lacking.
Purpose
We examined use of diuretic therapy before and one year after TAVI in order to identify the proportion of patients who had intensification of diuretic treatment after intervention as a proxy for more symptoms. We also examined baseline factors associated with an intensification event.
Methods
Using Danish nationwide registries, we identified all Danish citizens who underwent TAVI from January 1, 2008 to December 31, 2019 and were alive one year after the intervention. Diuretic use pre-TAVI and 1-year post-TAVI (based on prescription fillings) was divided into the following groups: 1) no use; 2) low diuretic use: 1–40 mg of furosemide (or equivalent bumetanide); 3) intermediate diuretic use: 41–120 mg of furosemide; and 4) high diuretic use: >120 mg furosemide. Diuretic intensification was defined as a change from one pre-TAVI diuretic group to a higher post-TAVI diuretic group. Factors associated with intensified diuretic treatment was examined with logistic regression. In this analysis of intensification, only patients who could potentially have an intensification event were included (i.e., no diuretic use, low diuretic use, or intermediate diuretic use groups).
Results
A total of 3,978 patients (median age 81 [interquartile range 77–85]; 54% men) undergoing TAVI were identified. Pre-TAVI, 1,279 (32%) had no diuretic use, 1,818 (46%) had low diuretic use and 881 (22%) had intermediate diuretic use. Overall, patients with pre-TAVI intermediate diuretic use had a greater burden of cardiovascular and non-cardiovascular comorbidities (higher prevalence of heart failure, atrial fibrillation, chronic kidney disease and diabetes) compared with those with no or low diuretic use. The distribution of age and sex was similar between diuretic groups. One year post-TAVI, 1,406 (35.3%) had no diuretic use, 1,635 (41.1%) had low diuretic use, 654 (16.4%) had intermediate diuretic use and 283 (7.1%) had high diuretic use (Figure 1). Overall, 1,077 (27%) patients had intensification of diuretic treatment one year after undergoing TAVI. Ischemic heart disease and chronic renal failure were associated with an intensification event (odds ratio 1.23 [95% CI 1.05–1.23] and 1.46 [95% CI 1.10–1.94], respectively).
Conclusion
Among patients undergoing TAVI not treated with high-dose diuretics at time of intervention, approximately 1 out of 4 patients had intensification of diuretic treatment one year after intervention. Ischemic heart disease and chronic renal failure were associated with intensification.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- X Begun
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - J H Butt
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - S L Kristensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - P E Weeke
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - O D Backer
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - M Schou
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - E L Fosboel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
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Madelaire C, Gustafsson F, Kristensen SL, Stevenson LW, Koeber L, Torp-Pedersen C, D'Souza M, Andersen J, Gislason G, Biering-Sorensen T, Andersson C, Schou M. P765One-year mortality risk after intensification of outpatient diuretics. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Mortality is increased following a hospitalization for heart failure (HF). It is not clear whether outpatient intensification of diuretic confers the same increased risk in the general population with heart failure
Purpose
This study sought to assess 1-year mortality risk after worsening HF, defined either as hospitalization due to HF or as intensified diuretic therapy in an outpatient setting, in a complete nationwide cohort of patients with HF on angiotensin converting enzyme inhibitors/ angiotensin receptor blocker and beta blockers.
Methods
From nationwide administrative registers, we identified all patients in Denmark diagnosed with HF in 2001–2016 and prescribed angiotensin converting enzyme inhibitor/ angiotensin receptor blocker and beta blocker within 120 days. During follow-up we defined worsening HF by the following events: Inpatient worsening (HF readmission) and outpatient worsening (intensified diuretic therapy, defined as the first event of new addition or doubled dosage of loop diuretic therapy or new onset addition of thiazide to loop diuretic therapy). Patients with a worsening event were risk set matched to two HF controls each at time of the event – based on age, sex and calendar year. One-year mortality risk was estimated with Kaplan-Meier and multivariable Cox regression models.
Results
We included 74,990 patients, median age 71 years (interquartile range: 62–79), 36% women. During five years of follow up, 8,727 patients had an inpatient worsening event, and 12,290 had an outpatient worsening event as first event. Absolute risk of 1-year mortality was 22.6% (95%-confidence interval (95%-CI): 21.7%-23.5%) after inpatient worsening, 18.0% (95%-CI: 17.3%-18.7%) after outpatient worsening compared to 9.8% (95%-CI: 9.5%-10.1%) for the matched controls. In a multivariable Cox model adjusted ischemic heart disease, atrial fibrillation, chronic obstructive pulmonary disease and diabetes, the hazard ratio for mortality among patients experiencing inpatient worsening was 2.46 (95%-CI: 2.33–2.60) and for outpatient worsening was 1.87 (95%-CI: 1.77–1.97), compared with the matched HF controls as reference (figure 1). Among patients who had an outpatient worsening as first event, 1,245 (10.1%) had a subsequent HF readmission within one year.
Conclusion
In a nationwide cohort of patients with HF, outpatient worsening defined by a diuretic intensification was associated with almost 2-fold risk of mortality during the next year. Although HF hospitalization is associated with a higher risk, the need to intensify diuretics in the outpatient setting is a signal to review and intensify efforts to improve HF outcomes.
Acknowledgement/Funding
The Danish Heart Foundation, (grant number 17-R116-A7610-22048)
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Affiliation(s)
- C Madelaire
- Gentofte University Hospital, department of cardiology, the cardiovascular research center, Copenhagen, Denmark
| | - F Gustafsson
- Rigshospitalet - Copenhagen University Hospital, Department of cardiology, Copenhagen, Denmark
| | - S L Kristensen
- Rigshospitalet - Copenhagen University Hospital, Department of cardiology, Copenhagen, Denmark
| | - L W Stevenson
- Vanderbilt University, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, United States of America
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of cardiology, Copenhagen, Denmark
| | - C Torp-Pedersen
- Aalborg University Hospital, Department of cardiology, Aalborg, Denmark
| | - M D'Souza
- Gentofte University Hospital, department of cardiology, the cardiovascular research center, Copenhagen, Denmark
| | - J Andersen
- The Danish Heart Foundation, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, department of cardiology, the cardiovascular research center, Copenhagen, Denmark
| | - T Biering-Sorensen
- Gentofte University Hospital, department of cardiology, the cardiovascular research center, Copenhagen, Denmark
| | - C Andersson
- Herlev Hospital, Department of cardiology, Herlev, Denmark
| | - M Schou
- Herlev Hospital, Department of cardiology, Herlev, Denmark
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9
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Ostergaard L, Andersson NW, Kristensen SL, Dahl A, Bundgaard H, Iversen K, Bruun NE, Gislason G, Pedersen CT, Valeur N, Kober L, Fosbol EL. P2756Risk of stroke subsequent to infective endocarditis: a nationwide study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with infective endocarditis (IE) are at high risk of cerebral embolization, however little is known about the risk of stroke subsequent to IE in patients with stroke during IE admission.
Purpose
To investigate the risk of stroke after discharge of IE in patients with stroke during IE admission compared with patients without stroke during IE admission.
Methods
Using Danish nationwide registries we identified non-surgically treated patients with IE discharged alive, in the period 1996–2016. The study population was grouped in 1) patients with stroke during IE admission and 2) patients without stroke during IE admission. Crude cumulative risk of stoke were calculated using the Aalen-Johansen estimator accounting for death as a competing risk. Multivariable adjusted Cox proportional hazard analysis was used to compare the associated risk of stroke between groups. We identified differentials in the associated risk of stroke during follow-up between groups (p=0.006 for interaction with time), and follow-up was split into 0–1 year and 1–5 years time periods.
Results
We identified 4,284 patients with IE, 239 patients (5.6%) with stroke during IE admission (median age: 71.9 years, 58.2% males), and 4,045 patients (94.4%) without stroke during IE admission (median age 69.7 years, 64.8% males). The crude cumulative risk of stroke within 1 year of follow-up is shown in Figure Panel A, and with 1 to 5 years of follow-up in Figure Panel B. In multivariable adjusted analyses, the associated risk of stroke was higher in patients with stroke during IE admission within a follow-up period of 1 year, HR 3.21 (95% CI: 1.66–6.20) compared with patients without stroke during IE admission. From 1 to 5 years of follow-up, we identified no difference in the associated risk of stroke between groups, HR 0.91 (95% CI: 0.33–2.50).
Cumulative incidence of stroke
Conclusion
Non-surgically treated patients with IE who had a stroke during IE admission were at significantly higher associated risk of subsequent stroke – although not significant beyond 1 year after discharge from IE. These findings underline the need for identification of causes and mechanisms of recurrent strokes after IE to develop preventive means.
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Affiliation(s)
- L Ostergaard
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Copenhagen, Denmark
| | - N W Andersson
- Statens Serum Institut, Department of epidemiology, Copenhagen, Denmark
| | - S L Kristensen
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Copenhagen, Denmark
| | - A Dahl
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Copenhagen, Denmark
| | - K Iversen
- Herlev Hospital - Copenhagen University Hospital, Department of cardiology, Copenhagen, Denmark
| | - N E Bruun
- University Hospital, Department of cardiology, Roskilde, Denmark
| | - G Gislason
- Gentofte University Hospital, Department of cardiology, Copenhagen, Denmark
| | - C T Pedersen
- Aalborg University Hospital, Department of clinical epidemiology and biostatistics, Aalborg, Denmark
| | - N Valeur
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Copenhagen, Denmark
| | - E L Fosbol
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Copenhagen, Denmark
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10
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Kristensen SL, Roerth R, Jhund PS, Beggs S, Kober L, Abraham WT, Desai A, Solomon S, Packer M, Rouleau J, Zile M, Dickstein K, Petrie MC, McMurray JJV. P2630Incidence and prognostic impact of new-onset left bundle branch block in patients with heart failure and reduced ejection fraction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac resynchronization therapy (CRT) improves survival in patients with heart failure, reduced ejection fraction (HFrEF) and left bundle branch block (LBBB). However, little is known about the incidence of LBBB in HFrEF and the risk factors for developing this. We addressed these questions in the PARADIGM-HF and ATMOSPHERE trials.
Methods
We identified 7703 patients with a non-paced rhythm on their baseline ECG, a QRS<130 ms, and at least one follow-up ECG (done at annual visits and end of study). Patients were stratified by baseline QRS duration (≤100 ms - reference; 101–115 ms and 116–129 ms) and followed until development of QRS duration ≥130 ms with a LBBB configuration or latest available ECG. The crude LBBB incidence rate per 100 person-years (py) was identified in the three QRS duration subgroups. Additionally, we examined risk of the primary composite outcome of cardiovascular death or HF hospitalization, and all-cause mortality, in patients with incident LBBB vs. no incident LBBB.
Results
Overall, 313 of 7703 patients (4%) developed LBBB during a mean follow-up of 2.7 years, yielding an incidence rate of 1.5 per 100 py. The rate ranged from 0.9 in those with QRS ≤100 ms to 4.0 per 100 py in patients with QRS 116–129 ms. Other predictors of incident LBBB included male sex, age, lower LVEF, HF duration and absence of AF. The risk of the primary composite endpoint was higher among those who developed incident LBBB vs no incident LBBB; event rates 13.5 vs 10.0 per 100 py, yielding an adjusted HR of 1.43 (1.05–1.96). For all-cause mortality the corresponding rates were 12.6 vs 7.3 per 100 py; HR 1.55 (1.16–2.07) (Table 1).
Table 1. Risk of outcomes according to incident LBBB during follow-up No. events Crude rate per 100py Adjusted* HR (95% CI) HF hospitalization or CV death No incident LBBB 2145 10.0 (9.6–10.4) 1.00 (ref.) Incident LBBB 43 13.5 (10.0–18.2) 1.43 (1.05–1.96) All-cause mortality No incident LBBB 1662 7.3 (6.9–7.6) 1.00 (ref.) Incident LBBB 48 12.6 (9.5–16.7) 1.55 (1.16–2.07)
Conclusion
Among patients with HFrEF, the annual incidence of new-onset LBBB (and a potential indication for CRT), was around 1.5%, ranging from 1% in those with QRS duration below 100 ms to 4% in those with QRS 116–129 ms. Incident LBBB was associated with a much higher risk of adverse outcomes, highlighting the importance of repeat ECG monitoring in patients with HFrEF.
Acknowledgement/Funding
Novartis
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Affiliation(s)
- S L Kristensen
- Gentofte Hospital - Copenhagen University Hospital, Department of Cardiology, Hellerup, Denmark
| | - R Roerth
- Cardiovascular Research Centre of Glasgow, Cardiology, Glasgow, United Kingdom
| | - P S Jhund
- Cardiovascular Research Centre of Glasgow, Cardiology, Glasgow, United Kingdom
| | - S Beggs
- Cardiovascular Research Centre of Glasgow, Cardiology, Glasgow, United Kingdom
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Cardiology, Copenhagen, Denmark
| | - W T Abraham
- Ohio State University Hospital, Cardiology, Columbus, United States of America
| | - A Desai
- Brigham and Womens Hospital, Cardiology, Boston, United States of America
| | - S Solomon
- Brigham and Womens Hospital, Cardiology, Boston, United States of America
| | - M Packer
- Baylor University Medical Center, Cardiology, Dallas, United States of America
| | - J Rouleau
- Montreal Heart Institute, Cardiology, Montreal, Canada
| | - M Zile
- Medical University of South Carolina, Charleston, United States of America
| | - K Dickstein
- Stavanger University Hospital, Cardiology, Stavanger, Norway
| | - M C Petrie
- Cardiovascular Research Centre of Glasgow, Cardiology, Glasgow, United Kingdom
| | - J J V McMurray
- Cardiovascular Research Centre of Glasgow, Cardiology, Glasgow, United Kingdom
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11
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Clausen M, Roerth R, Torp-Pedersen C, Gislason GH, Koeber L, Fosboel E, Kristensen SL. P4668Risk of valvular heart disease in bromocriptine-treated women with hyperprolactinaemic disorders. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Systematic echocardiographic screening is currently recommended for patients with hyperprolactinemic disorders treated with dopamine agonists, due to a perceived risk of cardiac valve regurgitation as observed in patients with Parkinson's disease. The dopamine agonist bromocriptine is used frequently in hyperprolactinemia patients, but its relation to cardiac valve disease remain uncertain.
Purpose
To determine the incidence of valvular heart disease in bromocriptine-treated women with hyperprolactinaemic disorders compared with matched controls from background population.
Methods
In nationwide Danish registries, we identified patients with hyperprolactinaemic disorders treated with bromocriptine between 1995–2017. Patients were matched 1:5 with population controls based on age and sex using incidence density sampling. We estimated the risk of valvular heart disease defined as admission and/or outpatient clinic visits. Incidence rates, cumulative incidence curve and adjusted cox-proportional hazard models were used to assess outcomes.
Results
A total of 23883 female bromocriptine users and 119415 controls were included. Median age was 29.9 years (Q1-Q3 26.4–33.8). Both groups had few comorbidities, 218 (0.9%) patients and 787 (0.7%) controls with hypertension, 160 (0.7%) patients and 629 (0.5%) controls with diabetes, 408 (1.7%) patients and 1305 (1.1%) controls were beta-blocker users. During a mean follow-up of 19 years 106 (0.44%) patients and 416 (0.35%) controls were diagnosed with valvular heart disease. Incidence rates were 0.254 per 1000 patient years (PY) in bromocriptine users (95% CI 0.21–0.31) and 0.198 per 1000 PY in the control cohort (95% CI 0.18–0.22). Overall, the cumulative incidence of valvular heart disease was 0.6% (95% CI 0.48–0.73) among patients and 0.5% (95% CI 0.4–0.51) among controls; P=0.03 (figure 1a). In adjusted analysis bromocriptine users still had a significant higher risk of valvular heart disease (hazard ratio=1.32, 95% CI 1.06–1.64, P=0.01).
Incidence of valvular heart disease
Conclusion
The use of bromocriptine in younger and otherwise healthy women with hyperprolactinaemic disorders, were associated with a low absolute risk of cardiac valve disease. Still risk was approximately 30% higher compared with age- and sex matched controls. Our study suggests a low clinical yield of echocardiographic screening in this patient population.
Acknowledgement/Funding
Internal grant, Copenhagen University Hospital Rigshospitalet
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Affiliation(s)
- M Clausen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - R Roerth
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Torp-Pedersen
- Aalborg University Hospital, Department of Health, Science and Technology, Aalborg, Denmark
| | - G H Gislason
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - E Fosboel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - S L Kristensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
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12
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Sigvardt FL, Hansen ML, Kristensen SL, Gustafsson F, Ghanizada M, Gislason GH, Madelair C. 5036Increased 1-year mortality among patients discharged following hospitalization for pericarditis - a nationwide cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pericarditis accounts for 5% of all chest pain referrals to the emergency department and is generally considered a benign condition. However, recent studies suggested that pericarditis can be an early predictor of malignant disease, but data on mortality and other morbidity after incident pericarditis is lacking.
Purpose
To assess mortality risk and hospitalization patterns in patients with incident pericarditis.
Methods
In nationwide Danish registries we identified patients discharged from hospital with a first-time diagnosis of pericarditis from 1996 to 2016. Patients with prior myocarditis, heart failure, myocardial infarction and recent thoracic surgery were excluded.
The patients were risk set matched with 8 controls each from the general population on sex and year of birth. We assessed 1-year mortality risk using Kaplan Meier and logistic regression adjusted for baseline comorbidities; cerebrovascular disease, chronic obstructive lung disease, cardiac dysrhythmias, ischaemic heart disease and malignancy. We identified subsequent hospital admissions due to new onset cardiovascular-, respiratory- or malignant disease. Differences in frequencies between the pericarditis group and controls were calculated with Chi squared test.
Results
We identified 8,077 patients with pericarditis, median age 45 years (IQR: 32–59) and 75.6% were men. The absolute 1-year mortality was 2.9% in patients with pericarditis compared to 0.8% in the control group (p<0.001) (Figure 1).
The adjusted odds ratio (OR) of 1-year mortality was 2.79 (95%-CI: 2.14–3.65, p<0.001). Within the first year after incident pericarditis, hospital admission due to recurrent pericarditis was observed in 10.6% of the patients. Further, we observed significantly higher frequencies of other hospital admissions compared to the matched controls; cardiovascular disease: 4.6% vs, 1.2%, p>0.001, respiratory disease: 3.4% vs. 0.7%, p>0.001) and malignant disease: 1.4% vs. 0.5%, p>0.001).
Figure 1
Conclusion
In a nationwide cohort of patients discharged from hospital with incident pericarditis, we observed more than a triple 1-year mortality compared to age- and sex matched controls. Further, we observed a higher frequency of both cardiovascular and non-cardiovascular hospital admissions, highlighting the need for more focus on underlying morbidity in patients presenting with pericarditis.
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Affiliation(s)
- F L Sigvardt
- Gentofte University Hospital, Copenhagen, Denmark
| | - M L Hansen
- Gentofte University Hospital, Copenhagen, Denmark
| | | | - F Gustafsson
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - M Ghanizada
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - G H Gislason
- Gentofte University Hospital, Copenhagen, Denmark
| | - C Madelair
- Gentofte University Hospital, Copenhagen, Denmark
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13
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Campbell R, Barton A, Docherty KF, Kristensen SL, Payne J, Dalzell JR, Gardner RS, McMurray JV, Petrie MC. P1652Limited correlation of calculated plasma volume status with invasive right heart pressures in patients with heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Estimated plasma volume (ePV) can be calculated from haematocrit and body weight, and has been shown to correlate with PV measured using 125Iodine labelled human serum albumin. Comparing a patient's ePV to ideal PV (iPV), an estimate of a patient's relative congestion, called PV status (PVS), is possible. Higher PVS is associated with increased mortality in patients with heart failure (HF), and has been proposed as a simple, cheap, and non-invasive way of assessing congestion.
Purpose
Whether PVS is associated with invasively measured markers of congestion is unknown. We calculated PVS in patients with HF who had right heart catheterisation (RHC), and assessed any correlation between PVS and invasive measures of congestion.
Methods
We calculated PVS in consecutive patients who had RHC performed as part of transplant assessment. iPV was calculated as: iPV = c × weight (kg) where c=39 in males and c=40 in females. ePV was calculated using subjects' haematocrit and weight as follows: ePV = (1 − haematocrit) × [a + (b × weight in kg)], where haematocrit is a fraction, a=1530 in males and a=864 in females, and b=41 in males and b=47.9 in females. PVS was calculated as: PVS = PVS = (ePV − iPV) /iPV × 100%. Correlation between PVS and invasive wedge pressure, mean right atrial (RA) pressure, and NTproBNP were made using Pearson correlation.
Results
PV indices and RHC data were available for 61 patients, 43 (71%) were male. Median age was 55 [IQR 48, 58] years. 20 (33%), 24 (39%), and 15 (25%) were NYHA association class II, III, and IV respectively. The median NTproBNP was 1390 [IQR 512, 3612] pg/ml and median ejection fraction was 29 [IQR 20, 35] %. The median PVS was −5.9% (IQR −12.5, −1.6]. Median wedge and mean-RA pressures were 14 [7, 21] and 4 [1, 8] mmHg, respectively. Correlation between mean RA pressure and PVS is shown in the figure. There was no correlation between PVS and mean RA pressure (r=0.12, p=0.34) or wedge pressure (r=0.01, p=0.92). There was a weak correlation between NTproBNP and PVS (r=0.31, p=0.01)
Correlation mean RA pressure and PVS
Conclusion
PVS did not correlate with the invasive measures of congestion, mean RA and wedge pressure, but was weakly correlated with NTproBNP. Although there were limited number of patients in this study, we question the conclusion that PVS is a marker of congestion, and whether it can be used clinically for this purpose.
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Affiliation(s)
- R Campbell
- Cardiovascular Research Centre of Glasgow, Glasgow, United Kingdom
| | - A Barton
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - K F Docherty
- Cardiovascular Research Centre of Glasgow, Glasgow, United Kingdom
| | | | - J Payne
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - J R Dalzell
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - R S Gardner
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - J V McMurray
- Cardiovascular Research Centre of Glasgow, Glasgow, United Kingdom
| | - M C Petrie
- Cardiovascular Research Centre of Glasgow, Glasgow, United Kingdom
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14
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Pallisgaard JL, Schjerning AM, Hansen ML, Johannessen A, Gustafsson F, Gislason GH, Torp-Pedersen C, Jacobsen PK, Kristensen SL, Koeber L, Schou M. 3377Ablation for atrial fibrillation with heart failure should be performed early a nationwide study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - A.-M Schjerning
- Herlev Hospital - Copenhagen University Hospital, Cardiology, Copenhagen, Denmark
| | - M L Hansen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - A Johannessen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - F Gustafsson
- Rigshospitalet - Copenhagen University Hospital, Cardiology, Copenhagen, Denmark
| | - G H Gislason
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - C Torp-Pedersen
- Aalborg University Hospital, Cardiology and Epidemiology, Aalborg, Denmark
| | - P K Jacobsen
- Rigshospitalet - Copenhagen University Hospital, Cardiology, Copenhagen, Denmark
| | | | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Cardiology, Copenhagen, Denmark
| | - M Schou
- Herlev Hospital - Copenhagen University Hospital, Cardiology, Copenhagen, Denmark
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15
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Roerth R, Kober L, Jhund PS, Kristensen SL, Aukrust P, Nymo SH, Ueland T, Wikstrand J, Kjekshus J, Gullestad L, McMurray JJV. P1803Biomarkers in heart failure patients with and without diabetes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Roerth
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - P S Jhund
- University of Glasgow, BHF Cardiovascular Research Centre, Glasgow, United Kingdom
| | - S L Kristensen
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - P Aukrust
- Oslo University Hospital, Cardiology, Oslo, Norway
| | - S H Nymo
- Oslo University Hospital, Cardiology, Oslo, Norway
| | - T Ueland
- Oslo University Hospital, Cardiology, Oslo, Norway
| | - J Wikstrand
- University of Gothenburg, Gothenburg, Sweden
| | - J Kjekshus
- Oslo University Hospital, Cardiology, Oslo, Norway
| | - L Gullestad
- Oslo University Hospital, Cardiology, Oslo, Norway
| | - J J V McMurray
- University of Glasgow, BHF Cardiovascular Research Centre, Glasgow, United Kingdom
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16
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Roerth R, Thune JJ, Nielsen JC, Haarbo J, Videbaek L, Korup E, Bruun NE, Eiskjaer H, Hassager C, Svendsen JH, Hoefsten D, Torp-Pedersen C, Pehrson S, Kober L, Kristensen SL. 3382Diabetes and risk of death in non-ischemic systolic heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Roerth
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - J J Thune
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - J C Nielsen
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - J Haarbo
- Gentofte University Hospital, Department of cardiology, Gentofte, Denmark
| | - L Videbaek
- Odense University Hospital, Odense, Denmark
| | - E Korup
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
| | - N E Bruun
- Gentofte University Hospital, Department of cardiology, Gentofte, Denmark
| | - H Eiskjaer
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - J H Svendsen
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - D Hoefsten
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - C Torp-Pedersen
- Aalborg University, Department of Health, Science and Technology, Aalborg, Denmark
| | - S Pehrson
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - S L Kristensen
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
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17
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Ahlehoff O, Wu JJ, Raunsø J, Kristensen SL, Khalid U, Kofoed K, Gislason G. Cutaneous lupus erythematosus and the risk of deep venous thrombosis and pulmonary embolism: A Danish nationwide cohort study. Lupus 2017; 26:1435-1439. [DOI: 10.1177/0961203317716306] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Venous thromboembolism (VTE) is a major public health concern. Lupus erythematosus (LE) is a chronic autoimmune disease ranging from localized cutaneous disease (CLE) to systemic involvement (SLE). Patients with SLE have an increased risk of venous thromboembolism (VTE), but little is known about the CLE-related risk of VTE. Methods To evaluate the risk of VTE in patients with SLE and CLE as compared to the general population, a retrospective cohort study was conducted. Incidence rates and hazard ratios (HRs) with 95% confidence intervals (CIs) from multivariable Cox regression models were used to evaluate and compare the risk of VTE. Registries of hospitalizations, outpatient visits, and prescription drug use were studied to determine the risk of VTE in patients with CLE and SLE and the general population between 1997 and 2011. Results A total of 3234 patients with CLE and 3627 patients with SLE were identified and compared to 5,590,070 individuals in the reference population. The incidence rates per 1000 year of VTE were higher in patients with LE, i.e. 1.20, 3.06, and 5.24 for the reference population, CLE, and SLE, respectively. In adjusted models, both CLE (HR 1.39; 95% CI 1.10–1.78) and SLE (HR 3.32; 95% CI 2.73–4.03) were associated with a statistically significant increased risk of VTE, compared to the reference population. Conclusion In this nationwide study, both CLE and SLE were significant risk factors for VTE. The results add to our understanding of comorbidities in patients with LE, and call for further studies and increased awareness of thromboembolic complications in patients with CLE.
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Affiliation(s)
- O Ahlehoff
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - J J Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - J Raunsø
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - S L Kristensen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - U Khalid
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - K Kofoed
- Department of Dermatology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - G Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
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Lamberts M, Nielsen OW, Lip GYH, Ruwald MH, Christiansen CB, Kristensen SL, Torp-Pedersen C, Hansen ML, Gislason GH. Cardiovascular risk in patients with sleep apnoea with or without continuous positive airway pressure therapy: follow-up of 4.5 million Danish adults. J Intern Med 2014; 276:659-66. [PMID: 25169419 DOI: 10.1111/joim.12302] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prognostic significance of age and continuous positive airway pressure (CPAP) therapy on cardiovascular disease in patients with sleep apnoea has not been assessed previously. METHODS Using nationwide databases, the entire Danish population was followed from 2000 until 2011. First-time sleep apnoea diagnoses and use of CPAP therapy were determined. Incidence rate ratios (IRRs) of ischaemic stroke and myocardial infarction (MI) were analysed using Poisson regression models. RESULTS Amongst 4.5 million individuals included in the study, 33 274 developed sleep apnoea (mean age 53, 79% men) of whom 44% received persistent CPAP therapy. Median time to initiation of CPAP therapy was 88 days (interquartile range 34-346). Patients with sleep apnoea had more comorbidities compared to the general population. Crude rates of MI and ischaemic stroke were increased for sleep apnoea patients (5.4 and 3.6 events per 1000 person-years compared to 4.0 and 3.0 in the general population, respectively). Relative to the general population, risk of MI [IRR 1.71, 95% confidence interval (CI) 1.57-1.86] and ischaemic stroke (IRR 1.50, 95% CI 1.35-1.66) was significantly increased in patients with sleep apnoea, in particular in patients younger than 50 years (IRR 2.12, 95% CI 1.64-2.74 and IRR 2.34, 95% CI 1.77-3.10, respectively). Subsequent CPAP therapy was not associated with altered prognosis. CONCLUSIONS Sleep apnoea is associated with increased risk of ischaemic stroke and MI, particularly in patients younger than 50 years of age. CPAP therapy was not associated with a reduced rate of stroke or MI.
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Affiliation(s)
- M Lamberts
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
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Kristensen SL, Ahlehoff O, Lindhardsen J, Erichsen R, Lamberts M, Khalid U, Nielsen OH, Torp-Pedersen C, Gislason GH, Hansen PR. Prognosis After First-Time Myocardial Infarction in Patients With Inflammatory Bowel Disease According to Disease Activity: Nationwide Cohort Study. Circ Cardiovasc Qual Outcomes 2014; 7:857-62. [DOI: 10.1161/circoutcomes.114.000918] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kristensen SL, Ramlau-Hansen CH, Ernst E, Olsen SF, Bonde JP, Vested A, Halldorsson TI, Becher G, Haug LS, Toft G. Long-term effects of prenatal exposure to perfluoroalkyl substances on female reproduction. Hum Reprod 2013; 28:3337-48. [DOI: 10.1093/humrep/det382] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Khalid U, Ahlehoff O, Gislason G, Kristensen SL, Skov L, Torp-Pedersen C, Hansen PR. Psoriasis is associated with increased risk of new-onset heart failure: a nationwide cohort study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lamberts M, Lip GYH, Ruwald MH, Ozcan C, Kristensen KE, Kristensen SL, Hansen ML, Kober L, Torp-Pedersen C, Gislason GH. Increased bleeding risk without thromboembolic protection with antiplatelet treatment on top of oral anticoagulation in heart failure patients with atrial fibrillation and co-existing vascular disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.3553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kristensen SL, Lindhardsen J, Ahlehoff O, Erichsen R, Lamberts M, Khalid U, Torp-Pedersen C, Nielsen OH, Gislason GH, Hansen PR. Inflammatory bowel disease increases the risk of atrial fibrillation, particularly during active disease stages. a nationwide cohort study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Benn Christiansen C, Gislason G, Torp-Pedersen C, Lamberts M, Kristensen SL, Olesen JB. Primary prevention of ischemic stroke: implication of multiple risk factors in patients with and without atrial fibrillation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lamberts M, Gislason GH, Kristensen SL, Olsen AMS, Mikkelsen AP, Christensen CB, Lip GYH, Kober L, Torp-Pedersen C, Hansen ML. Aspirin, clopidogrel or both in atrial fibrillation patients on oral anticoagulation following an acute coronary event. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.1605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ahlehoff O, Skov L, Gislason G, Lindhardsen J, Kristensen SL, Iversen L, Lasthein S, Gniadecki R, Dam TN, Torp-Pedersen C, Hansen PR. Cardiovascular disease event rates in patients with severe psoriasis treated with systemic anti-inflammatory drugs: a Danish real-world cohort study. J Intern Med 2013; 273:197-204. [PMID: 22963528 DOI: 10.1111/j.1365-2796.2012.02593.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Psoriasis is a chronic inflammatory disorder associated with cardiovascular morbidity and mortality. Systemic anti-inflammatory drugs, including biological agents, are widely used in the treatment of patients with moderate to severe psoriasis and may attenuate the risk of cardiovascular disease events. We therefore examined the rate of cardiovascular disease events in patients with severe psoriasis treated with systemic anti-inflammatory drugs. DESIGN, SETTING AND PARTICIPANTS Individual-level linkage of nationwide administrative databases was used to assess the event rates associated with use of biological agents, methotrexate or other therapies, including retinoids, cyclosporine and phototherapy, in Denmark from 2007 to 2009. MAIN OUTCOME MEASURE Death, myocardial infarction and stroke. RESULTS A total of 2400 patients with severe psoriasis, including 693 patients treated with biological agents and 799 treated with methotrexate, were identified. Incidence rates per 1000 patient-years and 95% confidence intervals (CIs) for the composite endpoint were 6.0 (95% CI 2.7-13.4), 17.3 (95% CI 12.3-24.3) and 44.5 (95% CI 34.6-57.0) for patients treated with biological agents, methotrexate and other therapies, respectively. Age- and sex-adjusted hazard ratios (HRs) were 0.28 (95% CI 0.12-0.64) and 0.65 (95% CI 0.42-1.00) for patients treated with biological agents and methotrexate, respectively, using other therapies as the reference cohort. Corresponding HRs for a secondary composite endpoint of cardiovascular death, myocardial infarction and stroke were 0.48 (95% CI 0.17-1.38) and 0.50 (95% CI 0.26-0.97). CONCLUSION In this nationwide study of patients with severe psoriasis, systemic anti-inflammatory treatment with biological agents or methotrexate was associated with lower cardiovascular disease event rates compared to patients treated with other anti-psoriatic therapies.
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Affiliation(s)
- O Ahlehoff
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
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Ernst A, Kristensen SL, Toft G, Thulstrup AM, Håkonsen LB, Ramlau-Hansen CH. Reply: Maternal smoking during pregnancy and age at menarche of premenopausal and post-menopausal daughters. Hum Reprod 2012; 28:552. [PMID: 23223437 DOI: 10.1093/humrep/des420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ruwald MH, Hansen ML, Lamberts M, Kristensen SL, Wissenberg M, Olsen AMS, Christensen SB, Vinther M, Kober L, Torp-Pedersen C, Hansen J, Gislason GH. Accuracy of the ICD-10 discharge diagnosis for syncope. Europace 2012; 15:595-600. [DOI: 10.1093/europace/eus359] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Ernst A, Kristensen SL, Toft G, Thulstrup AM, Håkonsen LB, Olsen SF, Ramlau-Hansen CH. Maternal smoking during pregnancy and reproductive health of daughters: a follow-up study spanning two decades. Hum Reprod 2012; 27:3593-600. [PMID: 23034153 DOI: 10.1093/humrep/des337] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION Does in utero exposure to constituents of cigarette smoke have a programming effect on daughters' age of menarche and markers of long-term reproductive health? SUMMARY ANSWER In utero exposure to constituents of cigarette smoke was associated with earlier age of menarche and--to a lesser extent--changes in the testosterone profile of the young women. WHAT IS KNOWN ALREADY Studies observe potential effects of in utero exposure to constituents of cigarette smoke on the intrauterine formation of female gonads, but the consequences on long-term reproductive health in daughters remain unclear. STUDY DESIGN, SIZE AND DURATION A prospective cohort study was designed using data from 965 pregnant women enrolled prior to a routine 30th-week antenatal examination at a midwifery practice in Denmark from 1988 to 1989 and a follow-up of their 19-21-year-old daughters in 2008. PARTICIPANTS/MATERIALS, SETTING AND METHODS The pregnant women provided information on lifestyle factors during pregnancy, including the exact number of cigarettes smoked per day during the first and the second trimesters. A total of 438 eligible daughters were asked to complete a web-based questionnaire on reproductive health and subsequently invited to participate in a clinical examination during 2008. Of the 367 daughters (84%) who answered the questionnaire, 267 (61%) agreed to further examination. Information on menstrual pattern was provided at examination, blood samples were drawn to be analyzed for serum levels of reproductive hormones [FSH, LH, estradiol (E(2)), sex hormone-binding globulin, anti-Müllerian hormone, dehydroepiandrosterone-sulphate (DHEAS), free testosterone and free E(2)] and number of follicles (2-9 mm) were examined by transvaginal ultrasound. The daughters were divided into three exposure groups according to the level of maternal smoking during first trimester [non-exposed (reference), low-exposed (mother smoking >0-9 cigarettes/day) and high-exposed (mother smoking ≥ 10 cigarettes/day)]. Data were analyzed by multiple regression analyses in which we adjusted for potential confounders. Both crude and adjusted test for trend were carried out using maternal smoking during the first trimester as a continuous variable. MAIN RESULTS AND THE ROLE OF CHANCE We observed an inverse association between in utero exposure to constituents of cigarette smoke and age of menarche (P = 0.001). Daughters exposed to >0-9 cigarettes/day debuted with -2.7 [95% confidence interval (CI) -5.2 to -0.1] percentage earlier age of menarche, whereas daughters exposed to ≥ 10 cigarettes/day had -4.1 (95% CI: -6.6 to -1.5) percentage earlier age of menarche corresponding to 6.5 (95% CI: -10.7 to -2.2) months. There was a non-significant tendency towards lower levels of testosterone and DHEAS with increasing in utero exposure to constituents of cigarette smoke but no associations with follicle number, cycle length or serum levels of the other reproductive hormones were observed. LIMITATIONS AND REASONS FOR CAUTION We collected information on age of menarche retrospectively but the recall time was relatively short (2-10 years) and the reported values were within the normal range of Caucasians. Analyses of reproductive hormones are presented only for the group of daughters who were non-users of hormonal contraceptives because users were excluded, leaving only a low number of daughters available for the analyses (n = 75), as reflected in the wide CIs. The analyses of hormones were further adjusted for menstrual phase at time of clinical examination (follicular, ovulation and luteal phase) because blood samples were not collected on a specific day of the menstrual cycle. WIDER IMPLICATIONS OF THE FINDINGS This study supports the limited evidence of an inverse association between maternal smoking during pregnancy and age of menarche and further addresses to what extent reproductive capacity and hormones may be programmed by maternal smoking during pregnancy. A trend toward earlier maturation of females is suggested to have implications on long-term reproductive function. STUDY FUNDING/COMPETING INTEREST(S) Supported by a scholarship from The Lundbeck Foundation (R93-A8476). No conflict of interest declared.
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Affiliation(s)
- A Ernst
- Department of Occupational Medicine, Aarhus University Hospital, Noerrebrogade 44, build 2C, Aarhus C DK-8000, Denmark.
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Kristensen SL, Ramlau-Hansen CH, Ernst E, Olsen SF, Bonde JP, Vested A, Toft G. A very large proportion of young Danish women have polycystic ovaries: is a revision of the Rotterdam criteria needed? Hum Reprod 2010; 25:3117-22. [DOI: 10.1093/humrep/deq273] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fujii R, Fujita S, Waseda T, Oka Y, Takagi H, Tomizawa H, Sasagawa T, Makinoda S, Cavagna M, Braga DPAF, Figueira RCS, Aoki T, Maldonado LGL, Iaconelli A, Borges E, Prabhakar S, Dittrich R, Beckmann MW, Hoffmann I, Mueller A, Kjotrod S, Carlsen SM, Rasmussen PE, Holst-Larsen T, Mellembakken J, Thurin-Kjellberg A, Haapaniemi Kouru K, Morin Papunen L, Humaidan P, Sunde A, von During V, Pappalardo S, Valeri C, Crescenzi F, Manna C, Sallam HN, Polec A, Raki M, Tanbo T, Abyholm T, Fedorcsak P, Tabanelli C, Ferraretti AP, Feliciani E, Magli MC, Fasolino C, Gianaroli L, Wang T, Feng C, Song Y, Dong MY, Sheng JZ, Huang HF, Sayyah Melli M, Kazemi-shishvan M, Snajderova M, Zemkova D, Pechova M, Teslik L, Lanska V, Ketel I, Serne E, Stehouwer C, Korsen T, Hompes P, Smulders Y, Voorstemans L, Homburg R, Lambalk C, Bellver J, Martinez-Conejero JA, Pellicer A, Labarta E, Alama P, Melo MAB, Horcajadas JA, Agirregoitia N, Peralta L, Mendoza R, Exposito A, Matorras R, Agirregoitia E, Ajina M, Chaouache N, Gaddas M, Souissi A, Tabka Z, Saad A, Zaouali-Ajina M, Zbidi A, Eguchi N, Jinno M, Watanabe A, Hirohama J, Hatakeyama N, Choi YM, Kim JJ, Kim DH, Yoon SH, Ku SY, Kim SH, Kim JG, Lee KS, Moon SY, Hirohama J, Jinno M, Watanabe A, Eguchi N, Hatakeyama N, Jinno M, Watanabe A, Hirohama J, Eguchi N, Hatakeyama N, Xiong Y, Liang X, Li Y, Yang X, Wei L, Makinoda S, Tomizawa H, Fujita S, Takagi H, Oka Y, Waseda T, Sasagawa T, Fujii R, Utsunomiya T, Chu S, Li P, Akarsu S, Dirican EK, Akin KO, Kormaz C, Goktolga U, Ceyhan ST, Kara C, Nadamoto K, Tarui S, Ida M, Sugihara K, Haruki A, Hukuda A, Morimoto Y, Albu A, Albu D, Sandu L, Kong G, Cheung L, Lok I, Pinto A, Teixeira L, Figueiredo H, Pires I, Silva Carvalho JL, Pereira ML, Faut M, de Zuniga I, Colaci D, Barrios E, Oubina A, Terrado Gil G, Motta A, Colaci D, de Zuniga I, Horton M, Faut M, Sobral F, Gomez Pena M, Motta A, Gleicher N, Barad DH, Li YP, Zhao HC, Spaczynski RZ, Guzik P, Banaszewska B, Krauze T, Wykretowicz A, Wysocki H, Pawelczyk L, Sarikaya E, Gulerman C, Cicek N, Mollamahmutoglu L, Venetis CA, Kolibianakis EM, Toulis K, Goulis D, Loutradi K, Chatzimeletiou K, Papadimas I, Bontis I, Tarlatzis BC, Schultze-Mosgau A, Griesinger G, Schoepper B, Cordes T, Diedrich K, Al-Hasani S, Gomez R, Jovanovic V, Sauer CM, Shawber CJ, Sauer MV, Kitajewski J, Zimmermann RC, Bungum L, Jacobsson AK, Rosen F, Becker C, Andersen CY, Guner N, Giwercman A, Kiapekou E, Zapanti E, Boukelatou D, Mavreli T, Bletsa R, Stefanidis K, Drakakis P, Mastorakos G, Loutradis D, Malhotra N, Sharma V, Kumar S, Roy KK, Sharma JB, Ferraretti A, Gianaroli L, Magli MC, Crippa A, Stanghellini I, Robles F, Serdynska-Szuster M, Spaczynski RZ, Banaszewska B, Pawelczyk L, Kristensen SL, Ernst E, Toft G, Olsen SF, Bonde JP, Vested A, Ramlau-Hansen CH, Wang FF, Qu F, Ding GL, Huang HF, Gallot V, Genro V, Roux I, Scheffer JB, Frydman R, Fanchin R, Kanta Goswami S, Banerjee S, Chakravarty BN, Kabir SN, Seeber BE, Morandell E, Kurzthaler D, Wildt L, Dieplinger H, Tutuncu L, Bodur S, Dundar O, Ron - El R, Seger R, Komarovsky D, Kasterstein E, Komsky A, Maslansky B, Strassburger D, Ben-Ami I, Zhao XM, Ni RM, Lin L, Dong M, Tu CH, He ZH, Yang DZ, Karamalegos C, Polidoropoulos N, Papanikopoulos C, Stefanis P, Argyrou M, Doriza S, Sisi V, Moschopoulou M, Karagianni T, Mentorou C, Economou K, Davies S, Mastrominas M, Gougeon A, De Los Santos MJ, Garcia-Laez V, Martinez-Conejero JA, Horcajadas JA, Esteban F, Labarta E, Crespo J, Pellicer A, Li HWR, Anderson RA, Yeung WSB, Ho PC, Ng EHY, Yang HI, Lee KE, Seo SK, Kim HY, Cho SH, Choi YS, Lee BS, Park KH, Cho DJ, Hart R, Doherty D, Mori T, Hickey M, Sloboda D, Norman R, Huang RC, Beilin L, Freiesleben N, Lossl K, Johannsen TH, Loft A, Bangsboll S, Hougaard D, Friis-Hansen L, Christiansen M, Nyboe Andersen A, Thum MY, Abdalla H, Martinez-Salazar J, De la Fuente G, Kohls G, Pellicer A, Garcia Velasco JA, Yasmin E, Kukreja S, Barth J, Balen AH, Esra T, Var T, Citil A, Dogan M, Cicek N, Messini CI, Dafopoulos K, Chalvatzas N, Georgoulias P, Anifandis G, Messinis IE, Celik O, Hascalik S, Celik N, Sahin I, Aydin S, Hanna CW, Bretherick KL, Liu CC, Stephenson MD, Robinson WP, Louwers YV, Goodarzi MO, Taylor KD, Jones MR, Cui J, Kwon S, Chen YDI, Guo X, Stolk L, Uitterlinden AG, Laven JSE, Azziz R, Navaratnarajah R, Grun B, Sinclair J, Dafou D, Gayther S, Timms JF, Hardiman PJ, Ye Y, Wu R, Ou J, Kim SD, Jee BC, Lee JY, Suh CS, Kim SH, Jung JH, Moon SY, Opmeer BC, Broeze KA, Coppus SF, Collins JA, Den Hartog JE, Land JA, Van der Linden PJ, Marianowski P, Ng E, Van der Steeg JW, Steures P, Strandell A, Mol BW, Tarlatzi TB, Kyrou D, Mertzanidou A, Fatemi HM, Tarlatzis BC, Devroey P, Batenburg TE, Konig TE, Overbeek A, Hompes P, Schats R, Lambalk CB, Carone D, Vizziello G, Vitti A, Chiappetta R, Topcu HO, Yuksel B, Islimye M, Karakaya J, ozat M, Batioglu S, Kuchenbecker WK, Groen H, Bolster JH, van Asselt S, Wolffenbuettel BH, Land JA, Hoek A, Wu Y, Pan H, Chen X, Wang T, Huang H, Zavos A, Dafopoulos K, Georgoulias P, Messini CI, Verikouki C, Messinis IE, Van Os L, Vink-Ranti CQJ, Rijnders PM, Tucker KE, Jansen CAM, Lucco F, Pozzobon C, Lara E, Galliano D, Pellicer A, Ballesteros A, Ghoshdastidar B, Maity SP, Ghoshdastidar B, Ghoshdastidar S, Luna M, Vela G, Sandler B, Barritt J, Flisser ED, Copperman AB, Nogueira D, Prat L, Degoy J, Bonald F, Montagut J, Ghoshdastidar S, Maity S, Ghoshdastidar B, Chen S, Chen X, Luo C, Zhen H, Shi X, Wu F, Ni Y, Merdassi G, Chaker A, Kacem K, Benmeftah M, Fourati S, Wahabi D, Zhioua F, Zhioua A, Saini P, Saini A, Sugiyama R, Nakagawa K, Nishi Y, Jyuen H, Kuribayashi Y, Sugiyama R, Inoue M, Jancar N, Vrtacnik Bokal E, Virant-Klun I, Lee JH, Kim SG, Cha EM, Park IH, Lee KH, Dahdouh EM, Desrosiers P, St-Michel P, Villeneuve M, Fontaine JY, Granger L, Ramon O, Matorras R, Burgos J, Abanto E, Gonzalez M, Mugica J, Corcostegui B, Exposito A, Tal J, Ziskind G, Ohel G, Paltieli Y, Paz G, Lewit N, Sendel H, Khouri S, Calderon I, van Gelder P, Al-Inany HG, Antaki R, Dean N, Lapensee L, Racicot M, Menard S, Kadoch I, Meylaerts LJ, Dreesen L, Vandersteen M, Neumann C, Zollner U, Kato K, Segawa T, Kawachiya S, Okuno T, Kobayashi T, Takehara Y, Kato O, Jayaprakasan K, Nardo L, Hopkisson J, Campbell B, Raine-Fenning N. Posters * Reproductive Endocrinology (i.e. PCOS, Menarche, Menopause etc.). Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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