-
Mette Charlot,
Erik L Grove,
Peter Riis Hansen, Jonas B Olesen,
Ole Ahlehoff,
Christian Selmer,
Jesper Lindhardsen,
Jan Kyst Madsen,
Lars Køber,
Christian Torp-Pedersen,
Gunnar H Gislason
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: To examine the effect of proton pump inhibitors on adverse cardiovascular events in aspirin treated patients with first time myocardial infarction. DESIGN: Retrospective nationwide propensity score matched study based on administrative data. Setting All hospitals in Denmark. PARTICIPANTS: All aspirin treated patients surviving 30 days after a first myocardial infarction from 1997 to 2006, with follow-up for one year. Patients treated with clopidogrel were excluded. MAIN OUTCOME MEASURES: The risk of the combined end point of cardiovascular death, myocardial infarction, or stroke associated with use of proton pump inhibitors was analysed using Kaplan-Meier analysis, Cox proportional hazard models, and propensity score matched Cox proportional hazard models. Results 3366 of 19,925 (16.9%) aspirin treated patients experienced recurrent myocardial infarction, stroke, or cardiovascular death. The hazard ratio for the combined end point in patients receiving proton pump inhibitors based on the time dependent Cox proportional hazard model was 1.46 (1.33 to 1.61; P<0.001) and for the propensity score matched model based on 8318 patients it was 1.61 (1.45 to 1.79; P<0.001). A sensitivity analysis showed no increase in risk related to use of H(2) receptor blockers (1.04, 0.79 to 1.38; P=0.78). Conclusion In aspirin treated patients with first time myocardial infarction, treatment with proton pump inhibitors was associated with an increased risk of adverse cardiovascular events.
BMJ 02/2013; 342:d2690. · 14.09 Impact Factor
-
Morten Lamberts,
Emil L Fosbøl,
Anne-Marie S Olsen,
Morten L Hansen,
Frederik Folke,
Søren L Kristensen, Jonas B Olesen,
Peter R Hansen,
Lars Køber,
Christian Torp-Pedersen,
Gunnar H Gislason
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Use of non-steroidal anti-inflammatory drugs (NSAIDs) has been associated with increased cardiovascular morbidity and mortality. The purpose of this study was to examine the effect of ongoing NSAID treatment at time of admission for myocardial infarction (MI) on prognosis. METHODS: All patients admitted with first-time MI in 1997-2006 were included by use of individual-level linkage of nationwide registries. By claimed prescription of NSAIDs, availability of tablets was estimated within 14days prior to inclusion and defined ongoing use. Risk of death within 30days and risk of death or MI within 1year was analyzed by logistic regression and Cox proportional-hazard models, respectively. RESULTS: A total of 97,458 patients were included (mean age 69.9 [SD 13.2] years and 62% males); the 30day and 1year mortality rates were 18.1% and 27.7%, respectively. Ongoing NSAID treatment was identified in 12,156 (12.5%) patients and 30-day mortality was significantly increased in patients receiving rofecoxib (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.22-1.68) and celecoxib (OR 1.23; CI 1.03-1.47) relative to no use of NSAIDs. Correspondingly, the 1-year rate of death or recurrent MI was significantly increased in patients receiving rofecoxib (hazard ratio [HR] 1.15; CI 1.04-1.27), celecoxib (HR 1.13; CI 1.01-1.26), diclofenac (HR 1.12; CI 1.04-1.20) or any NSAID use (HR 1.05; CI 1.02-1.09). No association was found for naproxen or ibuprofen. CONCLUSION: Ongoing treatment with NSAIDs and in particular the cyclooxygenase-2-selective inhibitors rofecoxib, celecoxib, and diclofenac is associated with worsened prognosis in patients admitted with first-time MI.
International journal of cardiology 10/2012; · 7.08 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Antithrombotic therapy is a cornerstone of treatment in patients with cardiovascular disease with bleeding being the most feared complication. This review describes the risk of bleeding related to different combinations of antithrombotic drugs used for cardiovascular disease: acute coronary syndrome (ACS), atrial fibrillation (AF), cerebrovascular (CVD) and peripheral arterial disease (PAD). Different risk assessment schemes and bleeding definitions are compared. The HAS-BLED risk score is recommended in patients with AF and in ACS patients with AF. In patients with ACS with or without a stent dual antiplatelet therapy with a P2Y12 receptor antagonist and acetylsalicylic acid (ASA) is recommended for 12 months, preferable with prasugrel or ticagrelor unless there is an additional indication of warfarin or increased risk of bleeding. In patients with AF, warfarin is recommended if the risk of stroke is moderate to high, but newer emerging antithrombotic drugs will be recommended along with/or preferred to warfarin in the nearby future.. Patients with CVD (without cardiogenic causes) are recommended clopidogrel treatment for secondary prevention, where as patients with PAD are recommended ASA or clopidogrel. With future implementation of new antithrombotic treatment regimens as monotherapy and in combinations with antiplatelet therapy, increased focus on risk of thromboembolic events and bleeding and individual tailoring of antithrombotic therapy is warranted.
Current pharmaceutical design 06/2012; · 4.41 Impact Factor
-
Journal of the American College of Cardiology 01/2012; 59(2):194-5; author reply 195. · 14.16 Impact Factor
-
Peter Weeke,
Fredrik Folke,
Gunnar H Gislason,
Freddy K Lippert, Jonas B Olesen,
Charlotte Andersson,
Mads Wissenberg,
Henrik E Poulsen,
Søren L Nielsen,
Lars Køber,
Christian Torp-Pedersen
[show abstract]
[hide abstract]
ABSTRACT: The underlying etiology of sudden cardiac death varies with age and is likely to be reflected in type and number of healthcare contacts. We aimed to determine the specific type of healthcare contact shortly before out-of-hospital cardiac arrest (OHCA) across ages.
OHCA patients were identified in the nationwide Danish Cardiac Arrest Register and Copenhagen Medical Emergency Care Unit (2001-2006). We matched every OHCA patients with 10 controls on sex and age. Healthcare contacts were evaluated 30 days before event by individual-level-linkage of nationwide registers.
We identified 16,924 OHCA patients, median age 70.0 years (Q1-Q3: 59-80). OHCA patients had a higher number of hospitalizations and received more pharmacotherapy compared to the control population across all ages (p for difference <0.001). OHCA patients aged 70-79 and 80-89 years had the highest proportion of hospitalizations (70%) and pharmacotherapy (73%), respectively. In general, the association between OHCA and hospitalizations and pharmacotherapy was more pronounced among the youngest OHCA patients compared to controls. OHCA patients in age groups 14-19, 20-29, 30-39 were ~5 times more likely to be in contact with the healthcare service than the control population (p for difference <0.001). Similarly, OHCA patients in the oldest age groups (60-69, 70-79, 80-89, >89) were <2 times more likely to be in contact with the healthcare services shortly before OHCA compared to the control population (p for difference <0.001).
Young OHCA patients are more likely to be in contact with the healthcare services compared with an age and sex matched control population suggestive of traits that make them stand out from the general population.
Resuscitation 11/2011; 83(5):584-90. · 3.60 Impact Factor
-
Europace 09/2011; 14(1):1-2. · 1.98 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Psoriasis is a chronic inflammatory disease and inflammation contributes to the pathogenesis of atrial fibrillation (AF) and ischaemic stroke. We therefore investigated the risk of these endpoints in patients with psoriasis.
Cohort study of the entire Danish population followed from 1997 to 2006 by individual-level-linkage of nationwide prospectively recorded registers. Multivariable Poisson's regression and sensitivity analyses were used to assess the psoriasis-related risk of AF and ischaemic stroke. A total of 36 765 patients with mild psoriasis and 2793 with severe psoriasis were compared with 4 478 926 individuals, i.e., the reference population. In patients with mild psoriasis, the adjusted rate ratios (RRs) for AF were 1.50 (1.21-1.86) and 1.16 (1.08-1.24) in patients aged <50 and ≥50 years, respectively. Patients with severe psoriasis had a higher risk of AF with RRs 2.98 (1.80-4.92) in patients aged <50 years and 1.29 (1.01-1.65) in patients aged ≥50 years. Patients with psoriasis also demonstrated a disease severity-dependent increased risk of ischaemic stroke, i.e. RRs 1.97 (1.66-2.34) and 2.80 (1.81-4.34) in patients aged <50 years with mild and severe psoriasis, and RRs 1.13 (1.04-1.21) and 1.34 (1.04-1.71) in patients aged ≥50 years with mild and severe psoriasis, respectively. A range of sensitivity analyses yielded comparable results.
Psoriasis is associated with increased risk of AF and ischaemic stroke. These novel results add to a growing body of evidence, suggesting that patients with psoriasis could be considered at increased cardiovascular risk.
European Heart Journal 08/2011; 33(16):2054-64. · 10.48 Impact Factor
-
Charlotte Andersson,
Gunnar H Gislason,
Casper H Jørgensen,
Peter R Hansen,
Allan Vaag,
Rikke Sørensen,
Charlotte Mérie, Jonas B Olesen,
Peter Weeke,
Michelle Schmiegelow,
Mette L Norgaard,
Lars Køber,
Christian Torp-Pedersen
[show abstract]
[hide abstract]
ABSTRACT: The aim was to investigate the outcomes of individual sulfonylureas in patients with heart failure (HF).
All patients hospitalized with HF for the first time in 1997-2006, alive 30 days after discharge, and who received anti-diabetic monotherapy with glimepiride (n=1097), glibenclamide (glyburide) (n=1031), glipizide (n=557), gliclazide (n=251), or tolbutamide (n=541) were identified from nationwide registers. Risk of all-cause mortality was assessed by multivariable Cox regression models.
Over the median observational time of 744 (Inter Quartile Range 268-1451) days, 2242 patients (64%) died. The analysis demonstrated similar hazard ratio (HR) for mortality for treatment with glimepiride (1.10 [95% confidence interval 0.92-1.33]), glibenclamide (1.12 [0.93-1.34]), glipizide (1.14 [0.93-1.38]), tolbutamide (1.04 [0.85-1.26]), and gliclazide (reference). Grouped according to pancreatic specificity, i.e., with tolbutamide, glipizide, and gliclazide as specific, and glibenclamide, and glimepiride as non-specific agents, no differential prognosis was found between the two groups (HR 1.04 [0.96-1.14], for non-specific, compared to pancreas specific agents). The prognosis was not dependent on prior acute myocardial infarction or ischemic heart disease (p for interactions >0.3).
In current clinical practice, it is unlikely that there are considerable differences in risk of mortality associated with individual sulfonylureas in patients with heart failure.
Diabetes research and clinical practice 08/2011; 94(1):119-25. · 2.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Diabetes in patients with heart failure or myocardial infarction (MI) increases morbidity and mortality, but little is known about the impact of obesity on the risk of developing diabetes in these populations.
A cohort of patients consecutively hospitalized with heart failure (n = 3472) or MI (n = 5723) was followed in the period 1995-2006.
Multivariable Cox proportional-hazard models were used to estimate the risk of developing diabetes according to the World Health Organization body mass index (BMI) classification. Normal weight patients (BMI 18.5-24.9 kg/m(2)) were used as the reference.
In both populations, more than half of the patients with a BMI above 34.9 kg/m(2) developed diabetes. In heart failure patients, a BMI above 24.9 kg/m(2) was associated with an increased risk of diabetes for the three BMI groups, i.e. 25.0-29.9 kg/m(2), 30.9-34.9 kg/m(2), and >34.9 kg/m(2), with adjusted hazard ratios (HRs) of 2.16 (95% confidence interval 1.50-3.12), 3.89 (2.61-5.78), and 6.06 (3.79-9.69), respectively. In MI patients, the adjusted HRs in the three corresponding BMI groups were 1.84 (1.44-2.37), 4.31 (3.26-5.69), and 9.50 (6.70-13.46), respectively. Incident diabetes was associated with increased cardiovascular and all-cause mortality risks with adjusted HRs of greater magnitude than in prevalent diabetes.
BMI was an independent predictor of incident diabetes in patients with either heart failure or MI. More than half of the patients with a BMI above 34.9 kg/m(2) developed diabetes during follow-up. Incident diabetes carries an increased mortality risk.
European journal of cardiovascular prevention and rehabilitation: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology 04/2011; 18(2):305-11. · 2.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to determine the risk of adverse cardiovascular events associated with concomitant use of clopidogrel and calcium-channel blockers (CCBs) in patients with myocardial infarction (MI).
CCBs inhibit a variety of cytochrome P-450 enzymes, some of which contribute to clopidogrel metabolic activation. This interaction may diminish the efficacy of clopidogrel.
All patients surviving 30 days after a first-time MI in the period 2000 to 2006 in Denmark were identified by individual-level linkage of nationwide administrative registers. The cohort was divided into patients treated with and without clopidogrel and followed for 1 year after discharge. The risk of a composite of cardiovascular death, MI, or stroke and the risk of the individual components of the composite end point and all-cause death associated with CCBs were analyzed with multivariable Cox proportional hazard models and in univariate propensity score-matched models.
A total of 56,800 patients were included, of whom 24,923 were treated with clopidogrel and 13,380 with CCBs. In the Cox analyses, the risk of the composite end point associated with CCBs was increased in both patients treated and not treated with clopidogrel, with a hazard ratio of 1.15 (95% confidence interval [CI]: 1.07 to 1.24) and 1.05 (95% CI: 1.01 to 1.11), respectively. The increased risk was independent of clopidogrel use; the hazard rate ratio was 1.08 (95% CI: 0.99 to 1.18). Analyses of all additional adverse end points and propensity score-matched models provided similar results.
The clinical efficacy of clopidogrel in patients with a recent MI is not modified by concomitant CCB treatment. This potential drug interaction is unlikely to have clinical significance.
Journal of the American College of Cardiology 01/2011; 57(4):409-17. · 14.16 Impact Factor
-
Charlotte Andersson,
Mette L Norgaard,
Peter R Hansen,
Emil L Fosbøl,
Michelle Schmiegelow,
Peter Weeke, Jonas B Olesen,
Jakob Raunsø,
Casper H Jørgensen,
Allan Vaag,
Lars Køber,
Christian Torp-Pedersen,
Gunnar H Gislason
[show abstract]
[hide abstract]
ABSTRACT: Heart failure (HF) is associated with increased insulin resistance, but the consequences of HF for development of diabetes are not well studied. The aim of the present study was to investigate the relationship between HF severity and risk of developing diabetes in a nationwide cohort of patients with myocardial infarction (MI).
Patients discharged from first-time MI during 1997-2006 and not previously treated with glucose-lowering medications (GLM) or loop diuretics were identified from Danish nationwide registers. Heart failure severity was determined by loop diuretic dosage after discharge. Patients were followed until first claimed prescription of GLM, death, or until the end of 2006. The cohort comprised 50 874 patients. A total of 3006 (6%) had mild (loop-diuretic dosage≤40 mg/day), 5383 (11%) moderate (>40-120 mg/day), and 1127 (2%) severe (>120 mg/day) HF. During follow-up, 2531 (5%) patients developed diabetes. Increasing HF severity was associated with increased risk of diabetes, but the use of renin-angiotensin system inhibitors (RASi) attenuated the risk (P-value for interaction between the HF group and RASi<0.05). Compared with no HF, the adjusted hazard ratios (95% confidence interval) for the development of diabetes were 1.34 (1.11-1.63), 1.63 (1.40-1.90), and 1.68 (1.25-2.25) for mild, moderate, and severe HF with RASi treatment; and 1.45 (1.13-1.88), 1.90 (1.56-2.33), and 3.02 (2.01-4.54) for mild, moderate, and severe HF without RASi treatment.
Heart failure predicts the development of diabetes in a severity-dependent manner among patients with MI. Focus on increased predisposition to diabetes is warranted and needs further investigations.
European Journal of Heart Failure 12/2010; 12(12):1333-8. · 4.90 Impact Factor
-
Peter Weeke,
Fredrik Folke,
Gunnar H Gislason,
Freddy K Lippert, Jonas B Olesen,
Charlotte Andersson,
Emil L Fosbøl,
Mette G Charlot,
Jørgen K Kanters,
Henrik E Poulsen,
Søren Loumann Nielsen,
Lars Køber,
Christian Torp-Pedersen
[show abstract]
[hide abstract]
ABSTRACT: For out-of-hospital cardiac arrest (OHCA) to be predicted and prevented, it is imperative the healthcare system has access to those vulnerable before the event occurs. We aimed to determine the extent of contact to the healthcare system before OHCA.
All patients in Denmark with a registered OHCA June 1, 2001-December 31, 2005 were matched on age and sex with 10 random controls from the entire Danish population. We estimated the association with OHCA by conditional logistic regression analyses, and we determined the proportion of patients in contact with the healthcare system before OHCA from hospital admissions or claimed prescriptions.
We identified 12,089 patients with an OHCA. Of these, 62% (7548) and 85% (10,312) were in contact with the healthcare system up to 30 days and 1 year before OHCA, respectively. Association with OHCA up to 30 days before the event pertained to myocardial infarction (odds ratio (OR)=6.4, 95% confidence interval (CI): 4.7-8.6)); heart failure (OR=5.1, CI: 4.1-6.3); ischemic heart disease (OR=1.9, CI: 1.6-2.4); and cardiac dysrhythmia (OR=1.8, CI: 1.4-2.2). Concomitant pharmacotherapy up to 30 days before OHCA with the strongest association was: corticosteroids (systemic) (OR=2.7, CI: 2.5-3.0), bronchial dilators (OR=2.5, CI: 2.3-2.7), anti-psychotic medication (OR=2.1, CI: 1.9-2.3), and digoxin (OR=2.1, CI: 2.0-2.3). Similar results were found for associations up to 1 year before OHCA.
Contrary to general belief, the majority of OHCA patients are in contact with the healthcare system shortly before OHCA.
Resuscitation 12/2010; 81(12):1657-63. · 3.60 Impact Factor
