Objectives
The aim of this study is to determine major adverse cardiovascular events (MACE) and all-cause mortality comparing between xanthine oxidase inhibitors (XOIs) and non-XOI users, and between allopurinol and febuxostat.
Methods
This is a retrospective cohort study of gout patients prescribed anti-hyperuricemic medications between 2013 and 2017 using a territory-wide administrative database. XOI users were matched 1:1 to XOI non-users using propensity scores. Febuxostat users were matched 1:3 to allopurinol users. Subgroup analyses were conducted based on colchicine use.
Results
Of the 13 997 eligible participants, 3607 (25.8%) were XOI users and 10 390 (74.2%) were XOI non-users. After propensity score matching, compared with non-users (n = 3607), XOI users (n = 3607) showed similar incidence of MACE (hazard ratio [HR]: 0.997, 95% CI, 0.879, 1.131; P>0.05) and all-cause mortality (HR = 0.972, 95% CI 0.886, 1.065, P=0.539). Febuxostat (n = 276) users showed a similar risk of MACE compared with allopurinol users (n = 828; HR: 0.672, 95% CI, 0.416, 1.085; P=0.104) with a tendency towards a lower risk of heart failure-related hospitalizations (HR = 0.529, 95% CI 0.272, 1.029; P=0.061). Concurrent colchicine use reduced the risk for all-cause mortality amongst XOI users (HR = 0.671, 95% 0.586, 0.768; P<0.001).
Conclusion
In gout patients, XOI users showed similar risk of MACE and all-cause mortality compared with non-users. Compared with allopurinol users, febuxostat users showed similar MACE and all-cause mortality risks but lower heart failure-related hospitalizations.
Heart failure (HF) is a major epidemic with rising morbidity and mortality rates that encumber global healthcare systems. While some studies have demonstrated the value of CRP in predicting (i) the development of HFpEF and (ii) long-term clinical outcomes in HFpEF patients, others have shown no such correlation. As a result, we conducted the following systematic review and meta-analysis to assess both the diagnostic and prognostic role of CRP in HFpEF. PubMed and Embase were searched for studies that assess the relationship between CRP and HFpEF using the following search terms: (((C-reactive protein) AND ((preserved ejection fraction) OR (diastolic heart failure))). The search period was from the start of database to August 6, 2019, with no language restrictions. A total of 312 and 233 studies were obtained from PubMed and Embase respectively, from which 19 studies were included. Our meta-analysis demonstrated the value of a high CRP in predicting the development of not only new onset HFpEF (HR: 1.08; 95% CI: 1.00-1.16; P = 0.04; I 2 = 22%), but also an increased risk of cardiovascular mortality when used as a categorical (HR: 2.52; 95% CI: 1.61-3.96; P < 0.0001; I 2 = 19%) or a continuous variable (HR: 1.24; 95% CI: 1.04-1.47; P = 0.01; I 2 = 28%), as well as all-cause mortality when used as a categorical (HR: 1.78; 95% CI: 1.53-2.06; P < 0.00001; I 2 = 0%) or a continuous variable: (HR: 1.06; 95% CI: 1.02-1.06; P = 0.003; I 2 = 61%) in HFpEF patients. CRP can be used as a biomarker to predict the development of HFpEF and long-term clinical outcomes in HFpEF patients, in turn justifying its use as a simple, accessible parameter to guide clinical management in this patient population. However, more prospective studies are still required to not only explore the utility and dynamicity of CRP in HFpEF but also to determine whether risk stratification algorithms incorporating CRP actually provide a material benefit in improving patient prognosis.
ObjectivesTo determine whether the use of angiotensin converting enzyme inhibitors (ACEIs) was associated with a higher risk of lung cancer when compared to use of angiotensin receptor blockers (ARBs).Study DesignPopulation-based cohort study.SettingPublic hospitals under the Hospital Authority in Hong Kong, P.R. China.MethodsPatients admitted to public hospitals and first prescribed with ACEI and/or ARB between 1 January 2001 and 31 December 2018 were analyzed. The last follow-up date was 31 August 2020, or death, whichever was earlier.OutcomesThe primary outcome was the incidence of lung cancer. Logistic regression was used to calculate odds ratio [ORs] with 95% confidence intervals associated with the use of ACEIs compared to ARBs. Incidence and odds ratios were estimated for temporal analysis of incident cancer risk associated with time since the first prescription of ACEI or ARB.ResultsIn the unmatched cohort, 56,697 patients and 357,011 patients were included the ARB and ACEI cohorts, with lung cancer incidence of 2.16% and 1.29%, respectively. Using 1:3 matching for ARB to ACEI users, the incidences were 2.32% and 1.29%. ACEI use was associated with increased risks of lung cancer both before (hazard ratio: 1.30 [1.21-1.40], P<0.0001) and after (1.40 [1.29-1.51], P<0.0001) matching. There was a dose-dependent relationship between ACEI exposure and lung cancer risk.ConclusionsACEI use was associated with increased risk of lung cancer compared with ARB use at all time points. Additionally, incidence risk increases with the duration of exposure.
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