1
|
Medina-Gómez OS. [Impact of the COVID-19 pandemic on cardiovascular disease mortality trends in Mexico, 2000-2022]. Semergen 2024; 50:102170. [PMID: 38306759 DOI: 10.1016/j.semerg.2023.102170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To estimate the impact of the COVID-19 pandemic on cardiovascular disease (CVD) mortality trends in Mexico. METHODS An ecological study was conducted where deaths from CVD reported in Mexico under the ICD-10 classification with codes I10 to I99 for the period 2000-2022 were analyzed. Age-standardized mortality rates were calculated at the national and state levels, then the annual percentage variation was estimated using joinpoint analysis to know the changes in the mortality trend in the period studied. RESULTS There was an increase of 27.96 deaths per 100,000 inhabitants from 2000 to 2022 in Mexico. The joinpoint analysis shows in the period 2019-2021 an annual percentage change at the national level of 17,398 and subsequently a negative trend is presented between the years 2021-2022. The states of Guanajuato, Tlaxcala and Querétaro showed the largest increases in CVD mortality trends during the COVID-19 pandemic. CONCLUSIONS The trend in CVD mortality in Mexico increased significantly during the COVID-19 pandemic.
Collapse
Affiliation(s)
- O S Medina-Gómez
- Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Ciudad de México, México.
| |
Collapse
|
2
|
Wang K, Fenton BT, Dao VX, Guirguis AB, Anthony SE, Skanderson M, Sico JJ. Trajectory of blood pressure after initiating anti-calcitonin gene-related peptide treatment of migraine: a target trial emulation from the veterans health administration. J Headache Pain 2023; 24:108. [PMID: 37582724 PMCID: PMC10426172 DOI: 10.1186/s10194-023-01640-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Calcitonin gene-related peptide (CGRP) is involved in migraine pathophysiology and blood pressure regulation. Although clinical trials have established the cardio-cerebrovascular safety profile of anti-CGRP treatment, limited high-quality real-world evidence exists on its long-term effects on blood pressure (BP). To address this gap, we examined the safety of anti-CGRP treatment on BP in patients with migraine headache in the Veterans Health Administration (VHA). METHODS We emulated a target trial of patients who initiated anti-CGRP treatment or topiramate for migraine prevention between May 17th, 2018 and February 28th, 2023. We calculated stabilized inverse probability weights to balance between groups and then used weighted linear mixed-effect models to estimate the systolic and diastolic BP changes over the study period. For patients without hypertension at baseline, we estimated the cumulative incidence of hypertension using Kaplan-Meier curve. We also used weight mixed-effect Poisson model to estimate the number of antihypertension medications for patients with hypertension at baseline. RESULTS This analysis included 69,589 patients and 554,437 blood pressure readings. of these, 18,880 patients received anti-CGRP treatment, and they were more likely to be women, have a chronic migraine diagnosis and higher healthcare utilization than those received topiramate. Among patients without hypertension at baseline, we found no significant differences in systolic BP changes over the four-year follow-up between anti-CGRP (slope [standard error, SE] = 0.48[0.06]) and topiramate treated patients (slope[SE] = 0.39[0.04]). The incidence of hypertension was similar for anti-CGRP and topiramate group (4.4 vs 4.3 per 100 person-years). Among patients with hypertension at baseline who initiated anti-CGRP treatment, we found a small but persistent effect on exacerbating hypertension during the first four years of treatment, as evidenced by a significant annual 3.7% increase in the number of antihypertensive medications prescribed (RR = 1.037, 95%CI 1.025-1.048). CONCLUSIONS Our findings suggest that anti-CGRP treatment is safe regarding blood pressure in patients without hypertension. However, for those with baseline hypertension, anti-CGRP treatment resulted in a small but persistent increase in the number of antihypertensives, indicating an exacerbation of hypertension. Future studies are needed to evaluate the cardio-cerebrovascular safety of anti-CGRP treatment beyond the first four years.
Collapse
Affiliation(s)
- Kaicheng Wang
- Department of Veterans Affairs, Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, Orange, CT, USA.
- Yale Center for Analytical Sciences, Yale School of Public Health, 300 George St STE 511, New Haven, CT, 06511, USA.
| | - Brenda T Fenton
- Department of Veterans Affairs, Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, Orange, CT, USA
- Pain Research, Informatics, Multi-Morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Vinh X Dao
- Pharmacy Benefits Management Services, VA Minneapolis Health Care System, Minneapolis, MN, USA
- Headache Center of Excellence, VA Minneapolis Health Care System, Minneapolis, MN, USA
| | - Alexander B Guirguis
- Pharmacy Benefits Management Services, VA Connecticut Healthcare System, West Haven, CT, USA
- Headache Center of Excellence, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Sarah E Anthony
- Department of Veterans Affairs, Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, Orange, CT, USA
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Melissa Skanderson
- Department of Veterans Affairs, Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, Orange, CT, USA
| | - Jason J Sico
- Department of Veterans Affairs, Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, Orange, CT, USA
- Headache Center of Excellence, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|