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Farashi S, Shahidi S, Sarihi A, Zarei M. Association of vitamin A and its organic compounds with stroke - a systematic review and meta-analysis. Nutr Neurosci 2023; 26:960-974. [PMID: 36004815 DOI: 10.1080/1028415x.2022.2111746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
PURPOSE The main purpose of this systematic review was to evaluate the association between the stroke (risk of stroke and the mortality due to stroke) and vitamin A, its organic compounds and its provitamins. METHOD Major databases including PubMed, Scopus, and Web of Science were searched. Studies with human samples were included for risk assessment. The association was assessed using odds ratio (log(OR)) and a random-effect model. I2 statistic, variance (tau2) and prediction interval were used for heterogeneity assessment. The funnel plot was used for publication bias. RESULTS Twenty-one studies including 5789 stroke patients were retrieved. Twenty studies had sufficient information for quantitative analyses. The pooled effect showed an inverse association between vitamin A and its organic compound with the risk of stroke (log(OR) = -0.46 95%CI (-0.81;-0.12)) and with the risk of mortality due to stroke (log(OR) = -0.39 95%CI (-0.74;-0.04)). However, according to subgroup analyses, the association was dependent on the compound in a way that retinol and beta-carotene were the most effective compounds. The effects of several confounding factors and the threshold levels for vitamin A and its organic compound on the effectiveness were discussed. CONCLUSION Insufficiency of retinol and beta-carotene significantly increased the risk of stroke; however, due to heterogeneity between studies more studies are needed for evaluating clinical significance of this outcome.
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Affiliation(s)
- Sajjad Farashi
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Siamak Shahidi
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Physiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abdolrahman Sarihi
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Physiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Zarei
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Physiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Poizeau F, Balusson F, Jonville-Béra AP, Nowak E, Drici MD, Scarabin PY, Droitcourt C, Dupuy A, Oger E. The cardiovascular safety of oral alitretinoin: a population-based cohort study involving 19 513 patients exposed to oral alitretinoin. Br J Dermatol 2021; 185:764-771. [PMID: 33735442 DOI: 10.1111/bjd.20069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Oral alitretinoin is a retinoid used for severe chronic hand eczema. Although caution is recommended for patients with uncontrolled dyslipidaemia or cardiovascular risk factors, the actual atherothrombotic risk has not been investigated thus far. OBJECTIVES To detect any excess of atherothrombotic events among patients exposed to alitretinoin, during treatment or in the 2 years following initiation. METHODS Using the French Health Insurance database, we compared the number of patients who had an atherothrombotic event (coronary artery disease, ischaemic stroke or peripheral artery disease requiring revascularization) in the population exposed to oral alitretinoin vs. the general population of the same age, sex and baseline cardiovascular risk, using standardized morbidity ratios (SMRs). RESULTS Between 2009 and 2017, 19 513 patients were exposed to oral alitretinoin in France. Sixty-four (0·3%) patients had an atherothrombotic event while on alitretinoin. Patients receiving alitretinoin experienced no more atherothrombotic events than the general population: patients without cardiovascular risk factors or previous atherothrombotic events had a SMR of 0·65 [95% confidence interval (CI) 0·26-1·34] during alitretinoin treatment, and 1·21 (95% CI 0·90-1·59) in the 2 years following initiation; patients with cardiovascular risk factors or previous atherothrombotic events had a SMR of 0·82 (95% CI 0·60-1·08) during alitretinoin treatment and 0·95 (95% CI 0·82-1·09) in the 2 years following initiation. Taken separately, SMRs for each outcome did not increase either. CONCLUSIONS These data from an exhaustive nationwide population-based study do not support an increase in the incidence of atherothrombotic events with alitretinoin use, regardless of the baseline cardiovascular risk of the patient.
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Affiliation(s)
- F Poizeau
- Univ Rennes, CHU Rennes, EA 7449 (Pharmacoepidemiology and Health Services Research) REPERES, Rennes, F 35043, France.,PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France.,Department of Dermatology, CHU Rennes, Rennes, France
| | - F Balusson
- Univ Rennes, CHU Rennes, EA 7449 (Pharmacoepidemiology and Health Services Research) REPERES, Rennes, F 35043, France
| | - A P Jonville-Béra
- Centre Régional de Pharmacovigilance, CHRU Tours, Tours, France.,Université de Tours, Université de Nantes, INSERM - U 1246, France
| | - E Nowak
- PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France.,University of Bretagne Occidentale, Brest University, Brest, France.,INSERM CIC 1412, CHRU Brest, Brest, France
| | - M D Drici
- Department of Clinical Pharmacology, University of Cote d'Azur Medical Center, Nice, France
| | - P Y Scarabin
- Centre de Recherche en Épidémiologie et Santé des Populations, INSERM UMRS1018, Paris-Saclay University, Villejuif, France
| | - C Droitcourt
- Univ Rennes, CHU Rennes, EA 7449 (Pharmacoepidemiology and Health Services Research) REPERES, Rennes, F 35043, France.,PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France.,Department of Dermatology, CHU Rennes, Rennes, France
| | - A Dupuy
- Univ Rennes, CHU Rennes, EA 7449 (Pharmacoepidemiology and Health Services Research) REPERES, Rennes, F 35043, France.,PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France.,Department of Dermatology, CHU Rennes, Rennes, France
| | - E Oger
- Univ Rennes, CHU Rennes, EA 7449 (Pharmacoepidemiology and Health Services Research) REPERES, Rennes, F 35043, France.,PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France
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Ghanshani S, Chen C, Lin B, Zhou H, Lee MS. Isotretinoin and Risk of Cardiovascular Events in Adults with Acne: A Population-based Retrospective Cohort Study. Am J Clin Dermatol 2021; 22:267-274. [PMID: 33180242 DOI: 10.1007/s40257-020-00568-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Case reports have suggested isotretinoin exposure may be associated with adverse cardiac events. There are limited data where the cardiovascular safety of isotretinoin is systematically evaluated. OBJECTIVE The aim of this study was to determine the strength of association between isotretinoin exposure and adverse cardiovascular events. METHODS This was a population-based retrospective cohort study within an integrated healthcare delivery system. Adults ≥ 18 years of age with acne between 2009 and 2018 were included. Exposure to isotretinoin was identified using pharmacy records, and propensity score 1:1 matching was performed. The primary outcome was a composite of cardiovascular outcomes, including acute myocardial infarction, heart failure, and all-cause death. RESULTS The cohort consisted of 12,140 adults (10.5%) exposed to isotretinoin and 103,126 adults who were never exposed. Mean follow-up was 7.1 ± 2.9 years. After propensity score 1:1 matching, 23,844 patients were included. The rates of the composite cardiovascular outcomes were 0.47 versus 0.48 per 1000 person-years in the isotretinoin and non-exposed groups, respectively. No significant association was observed between isotretinoin treatment and the composite cardiovascular outcomes (adjusted hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.62-1.58), all-cause mortality (adjusted HR 1.10, 95% CI 0.62-1.95), acute myocardial infarction (adjusted HR 1.00, 95% CI 0.33-3.09), congestive heart failure (adjusted HR 0.45, 95% CI 0.14-1.40), or atrial fibrillation (adjusted HR 0.44, 95% CI 0.12-1.65). CONCLUSIONS Among adult patients with acne, no association was found between exposure to isotretinoin and an increased risk of cardiovascular events. Physicians should not be discouraged from prescribing isotretinoin out of concern for cardiovascular effects.
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Karapınar T, Polat M, Buğdaycı G. Evaluation of subclinical atherosclerosis in Turkish patients with acne vulgaris receiving systemic isotretinoin. Dermatol Ther 2020; 33:e13307. [DOI: 10.1111/dth.13307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Tekden Karapınar
- Department of Dermatology and Venerology, Faculty of Medicine Bolu Abant Izzet Baysal University Bolu Turkey
| | - Mualla Polat
- Department of Dermatology and Venerology, Faculty of Medicine Bolu Abant Izzet Baysal University Bolu Turkey
| | - Güler Buğdaycı
- Department of Medical Biochemistry, Faculty of Medicine Bolu Abant Izzet Baysal University Bolu Turkey
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Vrignaud L, Simon C, Agier MS, Théophile H, Gras-Champel V, Beau-Salinas F, Lengellé C, Jonville-Béra AP. Alitrétinoïne (Toctino®) : données françaises de pharmacovigilance. Therapie 2019; 74:513-519. [DOI: 10.1016/j.therap.2019.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/09/2019] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
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Godoy-Gijón E, Meseguer-Yebra C, Palacio-Aller L, Godoy-Rocati DV, Lahoz-Rallo C. [New populations at increased cardiovascular risk: Cardiovascular disease in dermatological diseases]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28:143-153. [PMID: 26383179 DOI: 10.1016/j.arteri.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 06/05/2023]
Abstract
The increased cardiovascular risk in some dermatological diseases has been demonstrated in recent decades. Diseases such as psoriasis and systemic lupus erythematosus are currently included in the guidelines for prevention of cardiovascular disease. Other diseases such as androgenic alopecia, polycystic ovary syndrome, hidradenitis suppurativa or lichen planus have numerous studies that point to an increased risk, however, they have not been included in these guidelines. In this article we review the evidence supporting this association, in order to alert the clinician to the need for greater control in cardiovascular risk factors in these patients.
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Affiliation(s)
- Elena Godoy-Gijón
- Servicio de Dermatología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - Carmen Meseguer-Yebra
- Servicio de Dermatología, Hospital Virgen de la Concha, Complejo Asistencial de Zamora, Zamora, España
| | | | | | - Carlos Lahoz-Rallo
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España
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Acute myocardial infarction in a young woman on isotretinoin treatment. Int J Cardiol 2015; 181:39-41. [DOI: 10.1016/j.ijcard.2014.11.169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 11/23/2014] [Indexed: 11/24/2022]
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Oral corticosteroids and the risk of serious infections in patients with elderly-onset inflammatory bowel diseases. Am J Gastroenterol 2014; 109:1795-802; quiz 1803. [PMID: 25267328 DOI: 10.1038/ajg.2014.313] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 08/01/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Systemic corticosteroids are among the most common anti-inflammatory treatments in elderly-onset inflammatory bowel disease (IBD) patients. Steroid use and older age each independently predisposes to infections, and infections increase mortality in hospitalized older IBD patients. Therefore, our objective was to examine the risk of serious infections in elderly-onset IBD patients treated with oral corticosteroids, and explore how the timing of exposure affects the risk estimates. METHODS Using the health-care databases of the province of Quebec, Canada, we conducted a population-based cohort study with a nested case-control analysis. Incident IBD patients aged ≥66 years were identified. Conditional logistic regression was performed to estimate crude and adjusted rate ratios (aRRs) with 95% confidence intervals (CIs). RESULTS We identified 3,522 elderly-onset patients, of which 564 cases with serious infections were identified during a mean 4.4 years of follow-up (incidence rate 3.7 per 100 per year) and matched to 2,646 controls. The rate of serious infections was significantly higher in those exposed to oral corticosteroids any time during the previous 6-month period compared with those nonexposed (aRR 2.3; 95% CI 1.8-2.9). Those currently exposed (within 45 days) had a higher risk (aRR 2.8; 95% CI 2.1-3.7). The residual effect of oral corticosteroids remained marginally statistically significant up to the 90-day period before the index date (aRR 1.7; 95% CI 1.0-2.7). CONCLUSIONS We found an excess relative risk for serious infections in elderly-onset IBD patients on oral corticosteroid therapy. Those with current exposure demonstrated a higher vulnerability to infections.
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Studer-Heikenfeld J, Colella C. Isotretinoin: Reconsidering Management of Acne Vulgaris in Primary Care. J Nurse Pract 2014. [DOI: 10.1016/j.nurpra.2014.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Consiglio GP, Burden AM, Maclure M, McCarthy L, Cadarette SM. Case-crossover study design in pharmacoepidemiology: systematic review and recommendations. Pharmacoepidemiol Drug Saf 2013; 22:1146-53. [DOI: 10.1002/pds.3508] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 06/20/2013] [Accepted: 07/29/2013] [Indexed: 12/15/2022]
Affiliation(s)
- Giulia P. Consiglio
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario Canada
| | - Andrea M. Burden
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario Canada
| | - Malcolm Maclure
- Department of Anesthesiology, Pharmacology and Therapeutics; University of British Columbia; Vancouver British Columbia Canada
| | - Lisa McCarthy
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario Canada
- Women's College Research Institute; Toronto Ontario Canada
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Fatal Pulmonary Embolism following Achilles Tendon Repair: A Case Report and a Review of the Literature. Case Rep Orthop 2013; 2013:401968. [PMID: 23819088 PMCID: PMC3683453 DOI: 10.1155/2013/401968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 05/15/2013] [Indexed: 11/18/2022] Open
Abstract
Deep venous thrombosis (DVT) is a significant source of morbidity in orthopaedic surgery. It can progress to a pulmonary embolism, a significant source of mortality. Up to date, patients with Achilles tendon rupture routinely do not receive DVT chemical prophylaxis. We are presenting a case of fatal pulmonary embolism after a surgically treated Achilles tendon rupture in a forty-two-year-old male healthy patient. In the current body of the literature, the reported incidence of DVT after Achilles tendon rupture is highly variable ranging from less than 1% to 34%, and there is a disagreement in the international guidelines regarding the need of chemical DVT prophylaxis with this type of injury. Further research needs to be conducted to investigate the risks and benefits of chemical DVT prophylaxis following Achilles tendon rupture. For low-risk patients, the use of milder forms of prophylaxis such as aspirin should also be explored.
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Chen YJ, Chang YT, Shen JL, Chen TT, Wang CB, Chen CM, Wu CY. Association between systemic antipsoriatic drugs and cardiovascular risk in patients with psoriasis with or without psoriatic arthritis: A nationwide cohort study. ACTA ACUST UNITED AC 2012; 64:1879-87. [DOI: 10.1002/art.34335] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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