Immediate and past cumulative effects of oral glucocorticoids on the risk of acute myocardial infarction in rheumatoid arthritis: a population-based study

Aviña‐Zubieta, J Antonio; Abrahamowicz, Michał; Vera, Mary A. De; Choi, Hyon K.; Sayre, Eric C.; Rahman, Mushfiqur; Sylvestre, Marie‐Pierre; Wynant, Willy; Esdaile, John M.; Lacaille, Diane

doi:10.1093/rheumatology/kes353

Cited by 144 publications

(92 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, Population Data BC encompasses the comprehensive prescription drug database, PharmaNet [29], with data since 1995. Numerous general population-based studies have been successfully conducted using these databases [30][31][32][33][34].…”

Section: Data Sourcementioning

confidence: 99%

The risk of pulmonary embolism and deep venous thrombosis in systemic lupus erythematosus: A general population-based study

Aviña‐Zubieta

Vostretsova

Vera

et al. 2015

Seminars in Arthritis and Rheumatism

View full text Add to dashboard Cite

Objective-To estimate the future risk and time trends of newly diagnosed venous thromboembolism (VTE) in individuals with incident systemic lupus erythematosus (SLE) in the general population.Methods-Using a population-based database that includes all residents of British Columbia, Canada we conducted a study cohort of all patients with incident SLE and up to 10 age-, sex-, and entry-time-matched individuals from the general population. We compared incidence rates of pulmonary embolism (PE), deep venous thrombosis (DVT) and VTE between the two groups according to SLE disease duration. We calculated hazards ratios (HR), adjusting for confounders.Results-Among 4,863 individuals with SLE (86% female, mean age 48.9 years), the incidence rates (IRs) of PE, DVT, and VTE were 2.58, 3.33, and 5.32 per 1000 person-years, respectively, whereas the corresponding rates in the comparison cohort were 0.67, 0.57, and 1.11 per 1000 person-years. Compared with non-SLE individuals, the multivariable HRs among SLE patients were 3.04 (95% CI, 2.08-4.45), 4.46 (95% CI, 3.11-6.41) and 3.55 (95% CI, 2.69-4.69), respectively. The age-, sex-, and entry time-matched HRs for PE, DVT and VTE were highest Contributors: JAA-Z secured the funding source, and contributed to study conception, study design, data analysis/interpretation, and critical review of the manuscript. KV and MDV contributed to data analysis/interpretation and drafted the manuscript. ES contributed to data analysis and manuscript preparation. HKC secured some of the funding sources, and contributed to study conception/design, data analysis/interpretation, and critical review of the manuscript. Conclusion-These findings provide population-based evidence that patients with SLE have a substantially increased risk of VTE, especially in the first year after SLE diagnosis. Awareness and increased vigilance of this potentially fatal, but preventable, complication is recommended.

show abstract

Section: Data Sourcementioning

confidence: 99%

The risk of pulmonary embolism and deep venous thrombosis in systemic lupus erythematosus: A general population-based study

Aviña‐Zubieta

Vostretsova

Vera

et al. 2015

Seminars in Arthritis and Rheumatism

View full text Add to dashboard Cite

show abstract

“…Several effects may contribute to this increased risk, such as effects on prostacyclin and thromboxane A2, nitric oxide, blood pressure and endothelial and renal functions [85]. Corticosteroids also appear to increase the incidence of AMI [86]. Additionally, the attempted use of methylprednisolone in patients with AMI did not show benefit [87].…”

Section: Potential Therapeutic Targetsmentioning

confidence: 99%

Role of Vascular Inflammation in Coronary Artery Disease: Potential of Anti-inflammatory Drugs in the Prevention of Atherothrombosis

Moreira

Silva

Vieira

et al. 2014

Am J Cardiovasc Drugs

106

View full text Add to dashboard Cite

Coronary artery disease (CAD) and acute myocardial infarction (AMI) are inflammatory pathologies, involving interleukins (ILs), such as IL-1β, IL-6 and tumor necrosis factor (TNF)-α, and acute phase proteins production, such as for C reactive protein (CRP). The process begins with retention of low-density lipoprotein (LDL) and its oxidation inside the intima, with the formation of the "foam cells." Toll-like receptors and inflamassomes participate in atherosclerosis formation, as well as in the activation of the complement system. In addition to innate immunity, adaptive immunity is also associated with atherosclerosis through antigen-presenting cells, T and B lymphocytes. AMI also increases the expression of some ILs and promotes macrophage and lymphocyte accumulation. Reperfusion increases the expression of anti-inflammatory ILs (such as IL-10) and generates oxygen free radicals. Although CAD and AMI are inflammatory disorders, the only drugs with anti-inflammatory effect so far widely used in ischemic heart disease are aspirin and statins. Some immunomodulatory or immunosuppressive promising therapies, such as cyclosporine and colchicine, may have benefits in CAD. Methotrexate also has potential cardioprotective anti-inflammatory effects, through increased adenosine levels. The TETHYS trial (The Effects of mETHotrexate Therapy on ST Segment Elevation MYocardial InfarctionS trial) will evaluate low-dose methotrexate in ST elevation AMI. The CIRT (Cardiovascular Inflammation Reduction Trial), in turn, will evaluate low-dose methotrexate in patients with a high prevalence of subclinical vascular inflammation. The CANTOS (The Canakinumab Antiinflammatory Thrombosis Outcomes Study) will evaluate canakinumab in patients with CAD and persistently elevated CRP. The blockage of other potential targets, such as the IL-6 receptor, CC2 chemokine receptor and CD20, could bring benefits in CAD.

show abstract

“…Long-term corticosteroid therapy is one of the most widely used therapeutic strategies in EORA despite its well-known side effects, which include diabetes mellitus, glaucoma, cataracts, psychiatric disorders, osteoporosis, and myocardial infarction (1,6,7).…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Rituximab in Elderly Patients With Rheumatoid Arthritis Enrolled in a French Society of Rheumatology Registry

Payet

Soubrier

Perrodeau³

et al. 2014

Arthritis Care & Research

View full text Add to dashboard Cite

Objective. The aim of this study was to compare the efficacy and safety of rituximab (RTX) as a function of patient age. Methods. We included all rheumatoid arthritis patients in the AutoImmunity and Rituximab registry with a 2-year followup. Results. Of the 1,709 patients, 191 were age >75 years, 417 were ages 65-74 years, 907 were ages 50 -64 years, and 194 were age <50 years. At baseline, the elderly and very elderly patients presented with longer disease duration, a higher incidence of erythrocyte sedimentation rate and C-reactive protein level, a lower incidence of previous tumor necrosis factor ␣ (TNF␣) therapy, and a smaller number of previously used TNF␣ agents. Disease activity, rheumatoid factor (RF), or anti-cyclic citrullinated peptide (anti-CCP) antibodies and corticosteroid therapy were not statistically different among the groups. At 24 months, no significant difference was shown among the groups for RTX discontinuation rates (36.1% if age <50 years, 32.6% if ages 50 -64 years, 34.5% if ages 65-74 years, and 32.5% if age >75 years). The reasons for discontinuation (inefficacy, adverse events) were the same in all 4 groups. Infections were more common in the elderly. Patients ages 65-75 years were more likely to be good responders than nonresponders at 1 year of followup than patients age >75 years (odds ratio 3.81, 95% confidence interval 1.14 -12.79) after adjustment on disease duration, RF/anti-CCP positivity, corticosteroids, anti-TNF use, and baseline Disease Activity Score in 28 joints (DAS28). After the sixth month, the decrease in DAS28 score was less marked in the population age >75 years than in the group age <50 years. Conclusion. The efficacy and safety of RTX is affected by age.

show abstract

Immediate and past cumulative effects of oral glucocorticoids on the risk of acute myocardial infarction in rheumatoid arthritis: a population-based study

Abstract: GCs are associated with an increased risk of MI in RA. Our results suggest a dual effect of GCs on MI risk, an immediate effect mediated through current dosage and a long-term effect of cumulative exposure.

Cited by 144 publications

References 40 publications

The risk of pulmonary embolism and deep venous thrombosis in systemic lupus erythematosus: A general population-based study

The risk of pulmonary embolism and deep venous thrombosis in systemic lupus erythematosus: A general population-based study

Role of Vascular Inflammation in Coronary Artery Disease: Potential of Anti-inflammatory Drugs in the Prevention of Atherothrombosis

Efficacy and Safety of Rituximab in Elderly Patients With Rheumatoid Arthritis Enrolled in a French Society of Rheumatology Registry

Contact Info

Product

Resources

About