Effect on Risk of Stroke and Acute Myocardial Infarction of Nonselective Nonsteroidal Anti-Inflammatory Drugs in Patients With Rheumatoid Arthritis

Chen, Yih Ru; Hsieh, Fang I.; Chang, Chi Ching; Fang, Nai; Wu, Hsin Chiao; Chiou, Hung Yi

doi:10.1016/j.amjcard.2018.01.044

Cited by 19 publications

(14 citation statements)

References 23 publications

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“…114 Only 9 studies in our meta-analysis included patients with rheumatic conditions. 44,45,58,64,76,101,102,104,109 Our results showed a statistically significant CVR for these patients (RR, 1.28 [1.20-1.35]), similar to the increment showed in the main analysis.…”

Section: Discussionsupporting

confidence: 86%

“…However, it should be kept in mind that some inflammatory diseases, such as rheumatoid arthritis or ankylosing spondylitis, usually present with cardiovascular complications . Only 9 studies in our meta‐analysis included patients with rheumatic conditions . Our results showed a statistically significant CVR for these patients (RR, 1.28 [1.20‐1.35]), similar to the increment showed in the main analysis.…”

Section: Discussionsupporting

confidence: 85%

“…25 Twenty-eight studies estimated the effect of dose on the CVR. 12,[27][28][29][36][37][38]44,48,50,[53][54][55][56][57]59,63,64,69,74,82,[87][88][89]92,105,106,109 Results for each individual drug are shown in (Table 3).…”

Section: Meta-analysismentioning

confidence: 99%

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Cardiovascular Risk of Nonsteroidal Anti‐inflammatory Drugs and Classical and Selective Cyclooxygenase‐2 Inhibitors: A Meta‐analysis of Observational Studies

Arias

González

Fadrique

et al. 2018

The Journal of Clinical Pharma

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The purpose of this study was to review the published evidence on the clinical use of nonsteroidal anti-inflammatory drugs (NSAIDs) and to assess the cardiovascular risk (CVR) of cyclooxygenase-2 inhibitors (coxibs), excluding aspirin, by means of a meta-analytic procedure. A search was conducted on MEDLINE and EMBASE databases between October 1999 and June 2018. Cohort and case-control studies showing CVR as relative risk (RR), odds ratio, hazard ratio, or incidence rate ratio associated with NSAIDs versus no treatment were selected. We estimated the pooled RR and the 95% confidence interval (CI) for all NSAIDs as a whole and individually. Eighty-seven studies met the inclusion criteria. Overall, NSAIDs were found to be associated with a statistically significantly increased CVR (RR, 1.24 [95%CI, 1.19-1.28]). The risk was slightly higher for coxibs (RR, 1.22 [95%CI, 1.17-1.28]) as compared with nonselective NSAIDs (RR, 1.18 [95%CI, 1.12-1.24]). Data analysis by drug disclosed that rofecoxib (RR, 1.39 [95%CI, 1.31-1.47]), followed by diclofenac (RR, 1.34 [95%CI, 1.26-1.42]) and etoricoxib (RR, 1.27 [95%CI, 1.12-1.43]) were the NSAIDs associated with the highest CVR. Analysis by type of event showed that the highest risk corresponded to vascular events for both coxibs (RR, 2.18 [95%CI, 1.72-2.78]) and nonselective NSAIDs (RR, 2.46 [95%CI, 2.00-3.02]). The meta-analysis results suggest that the use of the marketed coxibs celecoxib and etoricoxib would be related to a statistically significant CVR increase. Etoricoxib CVR could be higher than that for celecoxib. This increment would be similar to classical NSAID CVR.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 85%

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Cardiovascular Risk of Nonsteroidal Anti‐inflammatory Drugs and Classical and Selective Cyclooxygenase‐2 Inhibitors: A Meta‐analysis of Observational Studies

Arias

González

Fadrique

et al. 2018

The Journal of Clinical Pharma

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“…Recently, Wang and Zhao investigated the effect of Kaempferitrin (23), a natural flavonoid glycoside comprehensively existed in plants, on MH7A cells. The related results suggested that Kaempferitrin (5,10, and 20 µM) can trigger apoptosis in MH7A cells by blocking activation of NF-κB and protein kinase B (Akt)/mammalian target of rapamycin (mTOR) pathways (Akt/mTOR) [93]. In 2018, Zhang et al reported that by photodynamic therapy, Hypericin (24) (0.25-4 µM) could induce NF-κB mediated apoptosis in MH7A cells via increasing ROS, cleaved Caspase-9, Cleaved PARP, whereas decreasing NF-κB p65 [94].…”

Section: Nf-κb Mediated Apoptotic Pathwaysmentioning

confidence: 96%

Apoptosis Induction of Fibroblast-Like Synoviocytes Is an Important Molecular-Mechanism for Herbal Medicine along with its Active Components in Treating Rheumatoid Arthritis

et al. 2019

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Rheumatoid arthritis (RA) is a known chronic autoimmune disease can cause joint deformity and even loss of joint function. Fibroblast-like synoviocytes (FLS), one of the main cell types in synovial tissues of RA patients, are key effector cells in the development of RA and are considered as promising therapeutic targets for treating RA. Herbal medicines are precious resources for finding novel agents for treating various diseases including RA. It is reported that induction of apoptosis in FLS is an important mechanism for the herbal medicines to treat RA. Consequently, this paper reviewed the current available references on pro-apoptotic effects of herbal medicines on FLS and summarized the related possible signal pathways. Taken together, the main related signal pathways are concluded as death receptors mediated apoptotic pathway, mitochondrial dependent apoptotic pathway, NF-κB mediated apoptotic pathways, mitogen-activated protein kinase (MAPK) mediated apoptotic pathway, endoplasmic reticulum stress (ERS) mediated apoptotic pathway, PI3K-Akt mediated apoptotic pathway, and other reported pathways such as janus kinase/signal transducers and activators of transcription (JAK-STAT) signal pathway. Understanding the apoptosis induction pathways in FLS of these herbal medicines will not only help clear molecular mechanisms of herbal medicines for treating RA but also be beneficial for finding novel candidate therapeutic drugs from natural herbal medicines. Thus, we expect the present review will highlight the importance of herbal medicines and its components for treating RA via induction of apoptosis in FLS, and provide some directions for the future development of these mentioned herbal medicines as anti-RA drugs in clinical.

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“…It has also been demonstrated that the use of nonselective nonsteroidal antiinflammatory drugs also increases the incidence of stroke by 39% [39]. In pa tients with RA recurrent strokes are also more frequent.…”

Section: Reumatologia 2020; 58/5mentioning

confidence: 99%

The importance of homocysteine in the development of cardiovascular complications in patients with rheumatoid arthritis

et al. 2020

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Rheumatoid arthritis (RA) not only leads to disability due to joint changes, but also significantly shortens the life expectancy of patients, mainly due to more frequent occurrence of heart attacks and strokes. Accelerated atherosclerosis in these patients is caused, among other factors, by high homocysteine (HCY) concentration in blood. Numerous studies have shown that treatment with vitamin B significantly reduces the concentration of HCY in blood, but does not reduce the risk of heart diseases. Recent studies have shown, however, that folic acid (FA) administration reduces the risk of stroke by 10–20%. Due to the fact that in patients with RA strokes are more frequent than in the general population and hyperhomocysteinemia (HHCY) is often found, determination of HCY concentration in blood is advisable, and in persons with HHCY it is recommended to use FA in primary and secondary stroke prevention.

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Effect on Risk of Stroke and Acute Myocardial Infarction of Nonselective Nonsteroidal Anti-Inflammatory Drugs in Patients With Rheumatoid Arthritis

Cited by 19 publications

References 23 publications

Cardiovascular Risk of Nonsteroidal Anti‐inflammatory Drugs and Classical and Selective Cyclooxygenase‐2 Inhibitors: A Meta‐analysis of Observational Studies

Cardiovascular Risk of Nonsteroidal Anti‐inflammatory Drugs and Classical and Selective Cyclooxygenase‐2 Inhibitors: A Meta‐analysis of Observational Studies

Apoptosis Induction of Fibroblast-Like Synoviocytes Is an Important Molecular-Mechanism for Herbal Medicine along with its Active Components in Treating Rheumatoid Arthritis

The importance of homocysteine in the development of cardiovascular complications in patients with rheumatoid arthritis

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