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Intiso D, Centra AM, Gravina M, Copetti M, Fontana A, Bartolo M, Filoni S, Di Rienzo F. Vitamin D Supplementation in Functional Recovery of Subjects with Severe Acquired Brain Injury: A Pilot Controlled Randomized Study. Neurotrauma Rep 2024; 5:606-616. [PMID: 39036429 PMCID: PMC11257121 DOI: 10.1089/neur.2023.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Low vitamin D (VD) has been associated with poor clinical course in several neurological diseases. Supplementation has been suggested to improve outcomes. Severe acquired brain injury (sABI) subjects have low VD levels and disabling conditions requiring rehabilitation. The aim of the present study was to evaluate if VD supplementation produced a better clinical course and a better functional outcome in sABI during rehabilitation. A randomized single-blind study was performed. sABI subjects were randomized to the VD supplementation group (VDsG) (initial dose of 50.000 UI and 1.000 daily) and usual care control group (CG). Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS), and Level of Cognitive Functioning (LCF) were used in assessing disability. A total of 73 subjects (42 M and 31 F; mean age 53.2 ± 15.7) were randomized: 36 (21 M and 15 F; mean age 57.52 ± 14.88) to VDsG and 37 (20 M and 17 F; mean age 48.28 ± 17.47) to CG. Both groups significantly improved after rehabilitation, and no between-group difference was observed. The mean score values for DRS, GOS, and LCF in VDsG were 18.83 ± 4.27 and 9.42 ± 5.83; 2.89 ± 0.32 and 3.78 ± 0.80; and 4.81 ± 1.70 and 7.53 ± 1.28, at admission and discharge, respectively. Likewise, mean values for DRS, GOS, and LCF in CG were 18.57 ± 4.80 and 9.84 ± 6.34; 2.84 ± 0.37 and 3.81 ± 0.94; and 4.97 ± 2.01 and 7.41 ± 1.32, respectively. VD supplementation did not improve functional outcomes in sABI during rehabilitation treatment.
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Affiliation(s)
- Domenico Intiso
- Unit of Neuro-rehabilitation, and Rehabilitation Medicine, IRCCS “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Foggia, Italy
| | - Antonello Marco Centra
- Unit of Neuro-rehabilitation, and Rehabilitation Medicine, IRCCS “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Foggia, Italy
| | - Michele Gravina
- Unit of Neuro-rehabilitation, and Rehabilitation Medicine, IRCCS “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Foggia, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, IRCCS “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Foggia, Italy
| | - Andrea Fontana
- Unit of Biostatistics, IRCCS “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Foggia, Italy
| | - Michelangelo Bartolo
- Department of Rehabilitation, Neurorehabilitation Unit, Habilita Care & Research, Zingonia, Italy
| | - Serena Filoni
- Unit of Neuro-rehabilitation, and Rehabilitation Medicine, IRCCS “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Foggia, Italy
| | - Filomena Di Rienzo
- Unit of Neuro-rehabilitation, and Rehabilitation Medicine, IRCCS “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Foggia, Italy
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Takeuchi Y, Hagiwawa Y, Komukai S, Matsuyama Y. Estimation of the causal effects of time-varying treatments in nested case-control studies using marginal structural Cox models. Biometrics 2024; 80:ujae005. [PMID: 38465985 DOI: 10.1093/biomtc/ujae005] [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: 02/28/2022] [Revised: 10/30/2023] [Accepted: 01/22/2024] [Indexed: 03/12/2024]
Abstract
When estimating the causal effects of time-varying treatments on survival in nested case-control (NCC) studies, marginal structural Cox models (Cox-MSMs) with inverse probability weights (IPWs) are a natural approach. However, calculating IPWs from the cases and controls is difficult because they are not random samples from the full cohort, and the number of subjects may be insufficient for calculation. To overcome these difficulties, we propose a method for calculating IPWs to fit Cox-MSMs to NCC sampling data. We estimate the IPWs using a pseudo-likelihood estimation method with an inverse probability of sampling weight using NCC samples, and additional samples of subjects who experience treatment changes and subjects whose follow-up is censored are required to calculate the weights. Our method only requires covariate histories for the samples. The confidence intervals are calculated from the robust variance estimator for the NCC sampling data. We also derive the asymptotic properties of the estimator of Cox-MSM under NCC sampling. The proposed methods will allow researchers to apply several case-control matching methods to improve statistical efficiency. A simulation study was conducted to evaluate the finite sample performance of the proposed method. We also applied our method to a motivating pharmacoepidemiological study examining the effect of statins on the incidence of coronary heart disease. The proposed method may be useful for estimating the causal effects of time-varying treatments in NCC studies.
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Affiliation(s)
- Yoshinori Takeuchi
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
- Division of Medical Statistics, Department of Social Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo 143-8540, Japan
| | - Yasuhiro Hagiwawa
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Sho Komukai
- Department of Biomedical Statistics, Graduate School of Medicine, Osaka University, Suita-shi, Osaka 565-0871, Japan
| | - Yutaka Matsuyama
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
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Zhang Y, Zhang G, Chen X. Elevated Calcium after Acute Ischemic Stroke Predicts Severity and Prognosis. Mol Neurobiol 2024; 61:266-275. [PMID: 37605095 DOI: 10.1007/s12035-023-03581-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023]
Abstract
The aim of this study is to investigate whether there is a correlation between serum calcium levels and clinical severity or functional outcome at discharge in Chinese patients with acute ischemic stroke. Data from 339 patients admitted to our hospital between July 2020 and July 2021 were analyzed. Baseline demographic and clinical information was collected within 24 h of admission, including serum calcium levels, stroke severity (measured by the National Institutes of Health Stroke Scale [NIHSS] score), and lesion volumes. The modified Rankin Scale [mRS] assessed functional outcomes at discharge. Our analysis showed that the median age of patients included in the study was 65 years (interquartile range [IQR], 60-70), and 60.8% were men. We found a positive correlation between serum calcium levels and stroke severity (r[spearman] = 0.266, P < 0.001), with calcium levels increasing as stroke severity increased. In a subgroup of 188 patients with available MRI data, serum calcium concentrations positively correlated with infarct size. Furthermore, in multivariate analysis, a calcium serum level in the highest quartile was associated with a higher risk of unfavorable outcome (odds ratios [OR] = 3.27; 95% confidence intervals [CI] = 1.91-5.59; P < 0.001). In conclusion, our study indicates that higher calcium serum levels are associated with stroke severity and early neurologic outcome after acute ischemic stroke, indicating that calcium may serve as a prognostic biomarker for stroke in Chinese patients.
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Affiliation(s)
- Yueqi Zhang
- Department of Neurology, Weifang People's Hospital, No.151 Guangwen Street, Weifang, Shandong Province, 26100, China
| | - Guangjian Zhang
- Department of Neurology, Weifang People's Hospital, No.151 Guangwen Street, Weifang, Shandong Province, 26100, China
| | - Xuecong Chen
- Department of Neurology, Weifang People's Hospital, No.151 Guangwen Street, Weifang, Shandong Province, 26100, China.
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Barreira-Hernández D, Rodríguez-Martín S, Gil M, Mazzucchelli R, Izquierdo-Esteban L, García-Lledó A, Pérez-Gómez A, Rodríguez-Miguel A, de Abajo FJ. Risk of Ischemic Stroke Associated with Calcium Supplements and Interaction with Oral Bisphosphonates: A Nested Case-Control Study. J Clin Med 2023; 12:5294. [PMID: 37629338 PMCID: PMC10455805 DOI: 10.3390/jcm12165294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Conflicting results about the association of calcium supplements (CS) with ischemic stroke (IS) have been reported. We tested this hypothesis by differentiating between CS alone (CaM) and CS with vitamin D (CaD) and between cardioembolic and non-cardioembolic IS. We examined the potential interaction with oral bisphosphonates (oBs). A nested case-control study was carried out. We identified incident IS cases aged 40-90 and randomly sampled five controls per case matched by age, sex, and index date. Current users were compared to non-users. An adjusted odds ratios (AOR) and 95% CI were computed through conditional logistic regression. Only new users were considered. We included 13,267 cases (4400 cardioembolic, 8867 non-cardioembolic) and 61,378 controls (20,147 and 41,231, respectively). CaM use was associated with an increased risk of cardioembolic IS (AOR = 1.88; 95% CI: 1.21-2.90) in a duration-dependent manner, while it showed no association with non-cardioembolic IS (AOR = 1.05; 95% CI: 0.74-1.50); its combination with oBs increased the risk of cardioembolic IS considerably (AOR = 2.54; 95% CI: 1.28-5.04), showing no effect on non-cardioembolic. CaD use was not associated with either cardioembolic (AOR = 1.08; 95% CI: 0.88-1.31) or non-cardioembolic IS (AOR = 0.98; 95% CI: 0.84-1.13) but showed a small association with cardioembolic IS when combined with oBs (AOR = 1.35; 95% CI: 1.03-1.76). The results support the hypothesis that CS increases the risk of cardioembolic IS, primarily when used concomitantly with oBs.
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Affiliation(s)
- Diana Barreira-Hernández
- Department of Biomedical Sciences (Pharmacology), University of Alcalá (IRYCIS), 28805 Alcalá de Henares, Spain; (D.B.-H.); (S.R.-M.); (A.R.-M.)
| | - Sara Rodríguez-Martín
- Department of Biomedical Sciences (Pharmacology), University of Alcalá (IRYCIS), 28805 Alcalá de Henares, Spain; (D.B.-H.); (S.R.-M.); (A.R.-M.)
| | - Miguel Gil
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency on Medicines and Medical Devices (AEMPS), 28022 Madrid, Spain;
| | - Ramón Mazzucchelli
- Rheumatology Department, University Hospital “Fundación Alcorcón”, 28922 Alcorcón, Spain;
| | - Laura Izquierdo-Esteban
- Stroke Unit, Department of Neurology, University Hospital “Príncipe de Asturias”, 28805 Alcalá de Henares, Spain;
| | - Alberto García-Lledó
- Department of Cardiology, University Hospital “Príncipe de Asturias”, 28805 Alcalá de Henares, Spain;
- Department of Medicine, University of Alcalá, 28805 Alcalá de Henares, Spain;
| | - Ana Pérez-Gómez
- Department of Medicine, University of Alcalá, 28805 Alcalá de Henares, Spain;
- Department of Rheumatology, University Hospital “Príncipe de Asturias”, 28805 Alcalá de Henares, Spain
| | - Antonio Rodríguez-Miguel
- Department of Biomedical Sciences (Pharmacology), University of Alcalá (IRYCIS), 28805 Alcalá de Henares, Spain; (D.B.-H.); (S.R.-M.); (A.R.-M.)
| | - Francisco J. de Abajo
- Department of Biomedical Sciences (Pharmacology), University of Alcalá (IRYCIS), 28805 Alcalá de Henares, Spain; (D.B.-H.); (S.R.-M.); (A.R.-M.)
- Clinical Pharmacology Unit, University Hospital “Príncipe de Asturias”, 28805 Alcalá de Henares, Spain
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Rodríguez-Martín S, Barreira-Hernández D, Mazzucchelli R, Gil M, García-Lledó A, Izquierdo-Esteban L, Pérez-Gómez A, Rodríguez-Miguel A, De Abajo FJ. Association of oral bisphosphonates with cardioembolic ischemic stroke: a nested case-control study. Front Pharmacol 2023; 14:1197238. [PMID: 37305544 PMCID: PMC10250719 DOI: 10.3389/fphar.2023.1197238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023] Open
Abstract
Background: Bisphosphonates have been reported to increase the risk of atrial fibrillation. Therefore, it is conceivable that they may increase the risk of cardioembolic ischemic stroke (IS). However, most epidemiological studies carried out thus far have not shown an increased risk of IS, though none separated by the main pathophysiologic IS subtype (cardioembolic and non-cardioembolic) which may be crucial. In this study, we tested the hypothesis that the use of oral bisphosphonates increases specifically the risk of cardioembolic IS, and explored the effect of treatment duration, as well as the potential interaction between oral bisphosphonates and calcium supplements and anticoagulants. Methods: We performed a case-control study nested in a cohort of patients aged 40-99 years, using the Spanish primary healthcare database BIFAP, over the period 2002-2015. Incident cases of IS were identified and classified as cardioembolic or non-cardioembolic. Five controls per case were randomly selected, matched for age, sex, and index date (first recording of IS) using an incidence-density sampling. The association of IS (overall and by subtype) with the use of oral bisphosphonates within the last year before index date was assessed by computing the adjusted odds ratios (AOR) and their 95% CI using a conditional logistic regression. Only initiators of oral bisphosphonates were considered. Results: A total of 13,781 incident cases of IS and 65,909 controls were included. The mean age was 74.5 (SD ± 12.4) years and 51.6% were male. Among cases, 3.15% were current users of oral bisphosphonates, while among controls they were 2.62%, yielding an AOR of 1.15 (95% CI:1.01-1.30). Of all cases, 4,568 (33.1%) were classified as cardioembolic IS (matched with 21,697 controls) and 9,213 (66.9%) as non-cardioembolic IS (matched with 44,212 controls) yielding an AOR of 1.35 (95% CI:1.10-1.66) and 1.03 (95% CI: 0.88-1.21), respectively. The association with cardioembolic IS was clearly duration-dependent (AOR≤1 year = 1.10; 95% CI:0.82-1.49; AOR>1-3 years = 1.41; 95% CI:1.01-1.97; AOR>3 years = 1.81; 95% CI:1.25-2.62; p for trend = 0.001) and completely blunted by anticoagulants, even in long-term users (AOR>1 year = 0.59; 0.30-1.16). An interaction between oral bisphosphonates and calcium supplements was suggested. Conclusion: The use of oral bisphosphonates increases specifically the odds of cardioembolic IS, in a duration-dependent manner, while leaves materially unaffected the odds of non-cardioembolic IS.
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Affiliation(s)
- Sara Rodríguez-Martín
- Department of Biomedical Sciences (Pharmacology), University of Alcalá (IRYCIS), Alcalá de Henares, Spain
| | - Diana Barreira-Hernández
- Department of Biomedical Sciences (Pharmacology), University of Alcalá (IRYCIS), Alcalá de Henares, Spain
| | - Ramón Mazzucchelli
- Rheumatology Department, University Hospital “Fundación Alcorcón”, Madrid, Spain
| | - Miguel Gil
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency on Medicines and Medical Devices, Madrid, Spain
| | - Alberto García-Lledó
- Department of Cardiology, University Hospital “Príncipe de Asturias”, Alcalá de Henares, Spain
- Department of Medicine, University of Alcalá, Alcalá de Henares, Spain
| | - Laura Izquierdo-Esteban
- Department of Neurology, Stroke Unit, University Hospital “Príncipe de Asturias”, Alcalá de Henares, Spain
| | - Ana Pérez-Gómez
- Department of Medicine, University of Alcalá, Alcalá de Henares, Spain
- Department of Rheumatology, University Hospital “Príncipe de Asturias”, Alcalá de Henares, Spain
| | - Antonio Rodríguez-Miguel
- Department of Biomedical Sciences (Pharmacology), University of Alcalá (IRYCIS), Alcalá de Henares, Spain
| | - Francisco J. De Abajo
- Department of Biomedical Sciences (Pharmacology), University of Alcalá (IRYCIS), Alcalá de Henares, Spain
- Clinical Pharmacology Unit, Universty Hospital “Príncipe de Asturias”, Alcalá de Henares, Spain
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Akgül E, Çifçili S, Apaydın Kaya Ç. Developing a post-stroke home care checklist for primary care professionals in Turkey: a modified Delphi study. Prim Health Care Res Dev 2023; 24:e22. [PMID: 36971010 PMCID: PMC10061270 DOI: 10.1017/s146342362300004x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/31/2022] [Accepted: 11/19/2022] [Indexed: 03/29/2023] Open
Abstract
AIM The aim of this study is to develop a post-stroke home care checklist for the use of primary care professionals. BACKGROUND Home care is an integral part of primary health care. In the literature, several scales are available to help determine elderly individuals' need for home care services; however, there are no standard care criteria or guidelines for the home care of stroke survivors. Therefore, a standardized post-stroke home care tool specific for use by primary care professionals is needed to identify patients' needs and to detect intervention areas. METHODS This is a checklist development study carried out between December 2017 and September 2018 in Turkey. A modified Delphi technique was used. In the first stage of the study, a literature review was carried out, a workshop was conducted with healthcare specialists in the stroke area, and a 102-item draft checklist was created. In the second stage, two written Delphi rounds were carried out via email with 16 healthcare professionals providing post-stroke home care. In stage three, the agreed items were reviewed, and similar items were grouped together to create the final checklist. FINDINGS A consensus was achieved in 93 of the 102 items. The final checklist, consisting of four main themes and 15 headings, was created. The four main areas of assessment in post-stroke home care are 'assessment of current status', 'identification of risks', 'evaluation of the care environment and caregiver', and 'planning follow-up care'. The Cronbach alpha reliability coefficient of the checklist was found to be 0.93. In conclusion, the PSHCC-PCP is the first checklist created to be used by primary care professionals in post-stroke home care. However, it needs to be assessed in terms of effectiveness and usefulness with further studies.
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Affiliation(s)
- Esra Akgül
- Department of Family Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Serap Çifçili
- Department of Family Medicine, Marmara University School of Medicine, Istanbul, Turkey
- Eastern Mediterranean University School of Medicine, Istanbul, Turkey
| | - Çiğdem Apaydın Kaya
- Department of Family Medicine, Marmara University School of Medicine, Istanbul, Turkey
- Eastern Mediterranean University School of Medicine, Istanbul, Turkey
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Rodríguez-Martín S, Barreira-Hernández D, Gil M, García-Lledó A, Izquierdo-Esteban L, De Abajo F. Influenza Vaccination and Risk of Ischemic Stroke: A Population-Based Case-Control Study. Neurology 2022; 99:e2149-e2160. [PMID: 36240087 DOI: 10.1212/wnl.0000000000201123] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To assess the relationship between influenza vaccination in the general population and risk of a first ischemic stroke (IS) during pre-epidemic, epidemic, and postepidemic periods. METHODS A nested case-control study was conducted in a Spanish primary care database over 2001-2015. Individuals aged 40-99 years with at least 1 year registry and no history of stroke or cancer were selected to conform the source cohort, from which incident IS cases were identified and classified as cardioembolic or noncardioembolic. Five controls per case were randomly selected, individually matched with cases for exact age, sex, and date of stroke diagnosis (index date). A patient was considered vaccinated when he/she had a recorded influenza vaccination at least 14 days before the index date within the same season. Adjusted odds ratios (aORs) and their respective 95% CIs were computed through a conditional logistic regression. Pneumococcal vaccination was used as a negative control. RESULTS From a cohort of 3,757,621 patients, we selected 14,322 incident IS cases (9,542 noncardioembolic and 4,780 cardioembolic) and 71,610 matched controls. Of them, 41.4% and 40.5%, respectively, were vaccinated yielding a crude OR of 1.05 (95% CI 1.01-1.10). Vaccinated patients presented a higher prevalence of vascular risk factors, diseases, and comedication than those nonvaccinated, and after full adjustment, the association of influenza vaccination with IS yielded an aOR of 0.88 (95% CI 0.84-0.92), appearing early (aOR15-30 days 0.79; 95% CI 0.69-0.92) and slightly declining over time (aOR>150 days 0.92; 95% CI 0.87-0.98). A reduced risk of similar magnitude was observed with both types of IS, in the 3 epidemic periods, and in all subgroups analyzed (men, women, individuals younger and older than 65 years of age, and those with intermediate and high vascular risk). By contrast, pneumococcal vaccination was not associated with a reduced risk of IS (aOR 1.08; 95% CI 1.04-1.13). DISCUSSION Results are compatible with a moderate protective effect of influenza vaccine on IS appearing early after vaccination. The finding that a reduced risk was also observed in pre-epidemic periods suggests that either the "protection" is not totally linked to prevention of influenza infection or it may be partly explained by unmeasured confounding factors.
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Affiliation(s)
- Sara Rodríguez-Martín
- From the Department of Biomedical Sciences (Pharmacology Sector) (S.R.-M., D.B.-H., F.J.D.A.), School of Medicine, University of Alcalá (IRYCIS); Clinical Pharmacology Unit (S.R.-M., D.B.-H., F.J.D.A.), University Hospital Príncipe de Asturias, Alcalá de Henares; Division of Pharmacoepidemiology and Pharmacovigilance (M.G.), Spanish Agency for Medicines and Medical Devices; Cardiology Department (A.G.-L.), University Hospital Príncipe de Asturias, Alcalá de Henares; Department of Medicine (A.G.-L.), School of Medicine, University of Alcalá; and Stroke Unit (L.I.-E.), Department of Neurology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Diana Barreira-Hernández
- From the Department of Biomedical Sciences (Pharmacology Sector) (S.R.-M., D.B.-H., F.J.D.A.), School of Medicine, University of Alcalá (IRYCIS); Clinical Pharmacology Unit (S.R.-M., D.B.-H., F.J.D.A.), University Hospital Príncipe de Asturias, Alcalá de Henares; Division of Pharmacoepidemiology and Pharmacovigilance (M.G.), Spanish Agency for Medicines and Medical Devices; Cardiology Department (A.G.-L.), University Hospital Príncipe de Asturias, Alcalá de Henares; Department of Medicine (A.G.-L.), School of Medicine, University of Alcalá; and Stroke Unit (L.I.-E.), Department of Neurology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Miguel Gil
- From the Department of Biomedical Sciences (Pharmacology Sector) (S.R.-M., D.B.-H., F.J.D.A.), School of Medicine, University of Alcalá (IRYCIS); Clinical Pharmacology Unit (S.R.-M., D.B.-H., F.J.D.A.), University Hospital Príncipe de Asturias, Alcalá de Henares; Division of Pharmacoepidemiology and Pharmacovigilance (M.G.), Spanish Agency for Medicines and Medical Devices; Cardiology Department (A.G.-L.), University Hospital Príncipe de Asturias, Alcalá de Henares; Department of Medicine (A.G.-L.), School of Medicine, University of Alcalá; and Stroke Unit (L.I.-E.), Department of Neurology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Alberto García-Lledó
- From the Department of Biomedical Sciences (Pharmacology Sector) (S.R.-M., D.B.-H., F.J.D.A.), School of Medicine, University of Alcalá (IRYCIS); Clinical Pharmacology Unit (S.R.-M., D.B.-H., F.J.D.A.), University Hospital Príncipe de Asturias, Alcalá de Henares; Division of Pharmacoepidemiology and Pharmacovigilance (M.G.), Spanish Agency for Medicines and Medical Devices; Cardiology Department (A.G.-L.), University Hospital Príncipe de Asturias, Alcalá de Henares; Department of Medicine (A.G.-L.), School of Medicine, University of Alcalá; and Stroke Unit (L.I.-E.), Department of Neurology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Laura Izquierdo-Esteban
- From the Department of Biomedical Sciences (Pharmacology Sector) (S.R.-M., D.B.-H., F.J.D.A.), School of Medicine, University of Alcalá (IRYCIS); Clinical Pharmacology Unit (S.R.-M., D.B.-H., F.J.D.A.), University Hospital Príncipe de Asturias, Alcalá de Henares; Division of Pharmacoepidemiology and Pharmacovigilance (M.G.), Spanish Agency for Medicines and Medical Devices; Cardiology Department (A.G.-L.), University Hospital Príncipe de Asturias, Alcalá de Henares; Department of Medicine (A.G.-L.), School of Medicine, University of Alcalá; and Stroke Unit (L.I.-E.), Department of Neurology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Francisco De Abajo
- From the Department of Biomedical Sciences (Pharmacology Sector) (S.R.-M., D.B.-H., F.J.D.A.), School of Medicine, University of Alcalá (IRYCIS); Clinical Pharmacology Unit (S.R.-M., D.B.-H., F.J.D.A.), University Hospital Príncipe de Asturias, Alcalá de Henares; Division of Pharmacoepidemiology and Pharmacovigilance (M.G.), Spanish Agency for Medicines and Medical Devices; Cardiology Department (A.G.-L.), University Hospital Príncipe de Asturias, Alcalá de Henares; Department of Medicine (A.G.-L.), School of Medicine, University of Alcalá; and Stroke Unit (L.I.-E.), Department of Neurology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
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Kim KJ, Kim MS, Hong N, Bae JH, Kim KJ, Kim NH, Rhee Y, Lee J, Kim SG. Cardiovascular risks associated with calcium supplementation in patients with osteoporosis: a nationwide cohort study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:568-577. [PMID: 34244740 DOI: 10.1093/ehjcvp/pvab054] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/15/2021] [Accepted: 07/07/2021] [Indexed: 11/14/2022]
Abstract
AIMS This study aimed to evaluate the real effects of calcium supplementation on cardiovascular outcomes within a population-based cohort. METHODS AND RESULTS From a nationwide health screening database in South Korea, a total of 11 297 patients with osteoporosis who had taken calcium supplementation with or without vitamin D for at least 90 days [total calcium group; calcium supplementation only (CaO), n = 567; calcium supplementation in combination with vitamin D (CaD), n = 10 730] were matched at a 1:1 ratio to patients who had not taken calcium supplements (control group) by using propensity scores. The overall mean age was 59.9 ± 8.8 years and the percentage of women was 87.9% in our study population. Over a median follow-up of 54 months, the incidence rate of composite cardiovascular diseases (CVDs) per 1000 person-years was not different between the groups: 9.73 in the total calcium group and 8.97 in the control group [adjusted hazard ratio (HR): 1.12; 95% confidence interval (CI): 0.99-1.28; P = 0.08]. However, calcium supplementation without vitamin D was associated with an increased risk of composite CVD (HR: 1.54; 95% CI: 1.17-2.04; P < 0.01), especially non-fatal myocardial infarction (HR: 1.89; 95% CI: 1.23-2.91; P < 0.01), compared with no calcium supplementation. CONCLUSION Our population-based study supported that taking calcium supplementation combined with vitamin D did not appear to be harmful to cardiovascular health, but reminded that calcium supplementation without vitamin D should be used carefully even in populations with low dietary calcium intake.
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Affiliation(s)
- Kyoung Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Min Sun Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Namki Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Hyun Bae
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Kyeong Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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9
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Calcium Supplementation, Risk of Cardiovascular Diseases, and Mortality: A Real-World Study of the Korean National Health Insurance Service Data. Nutrients 2022; 14:nu14122538. [PMID: 35745268 PMCID: PMC9230596 DOI: 10.3390/nu14122538] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 01/27/2023] Open
Abstract
Few studies have investigated the effects of calcium supplementation on cardiovascular outcomes in individuals with low calcium intake in real-world settings. This study examined the association between calcium supplementation and cardiovascular outcomes in the Korean population in a real-world setting. This large retrospective cohort study included patients aged ≥45 years first prescribed calcium supplements in 2010. Age- and sex-matched controls were recruited among those who had no prescription for calcium supplements. Longitudinal data were collected on 31 December 2018. Kaplan−Meier estimation and Cox proportional hazard regression analysis were performed. The cumulative incidence of acute myocardial infarction, ischemic stroke, and death was significantly higher in the calcium supplementation group than in the control group (p < 0.05 by log-rank test). The calcium supplementation group had a significantly higher risk of myocardial infarction, ischemic stroke, and death than the control group. Compared to the control group, the hazard ratios (95% confidence intervals) of the incidence of myocardial infarction, stroke, and death in the supplementation group were 1.14 (1.03−1.27), 1.12 (1.05−1.20), and 1.40 (1.32−1.50), respectively, after adjusting for confounding variables. Considering the associated cardiovascular risk, calcium supplementation for osteoporosis treatment should be administered cautiously.
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10
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Alqdwah-Fattouh R, Rodríguez-Martín S, Barreira-Hernández D, Izquierdo-Esteban L, Gil M, González-Bermejo D, Fernández-Antón E, Rodríguez-Miguel A, García-Lledó A, Bolúmar F, de Abajo FJ. Selective Serotonin Reuptake Inhibitors and Risk of Noncardioembolic Ischemic Stroke: A Nested Case-Control Study. Stroke 2022; 53:1560-1569. [PMID: 35109681 DOI: 10.1161/strokeaha.121.036661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple studies have reported that the use of selective serotonin reuptake inhibitors (SSRIs) is associated with an increased risk of ischemic stroke; however, this finding may be the result of a confounding by indication. We examined the association using different approaches to minimize such potential bias. METHODS A nested case-control study was carried out in a Spanish primary health-care database over the study period 2001 to 2015. Cases were patients sustaining an ischemic stroke with no sign of cardioembolic or unusual cause. For each case, up to 5 matched controls (for exact age, sex, and index date) were randomly selected. Antidepressants were divided in 6 pharmacological subgroups according to their mechanism of action. The current use of SSRIs (use within a 30-day window before index date) was compared with nonuse, past use (beyond 365 days) and current use of other antidepressants through a conditional logistic regression model to obtain adjusted odds ratios and 95% CI. Only initiators of SSRIs and other antidepressants were considered. RESULTS A total of 8296 cases and 37 272 matched controls were included. Of them, 255 (3.07%) were current users of SSRIs among cases and 834 (2.24%) among controls, yielding an adjusted odds ratio of 1.14 (95% CI, 0.97-1.34) as compared with nonusers, 0.94 (95% CI, 0.77-1.13) as compared with past-users and 0.74 (95% CI, 0.58-0.93) as compared with current users of other antidepressants. No relevant differences were found by duration (≤1, >1 year), sex, age (<70, ≥70 years old) and background vascular risk. CONCLUSIONS The use of SSRIs was not associated with an increased risk of noncardioembolic ischemic stroke. On the contrary, as compared with other antidepressants, SSRIs appeared to be protective.
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Affiliation(s)
- Rasha Alqdwah-Fattouh
- Unit of Epidemiology and Public Health. School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain (R.A.-F., F.B.)
| | - Sara Rodríguez-Martín
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.).,Department of Biomedical Sciences (Pharmacology Sector), School of Medicine, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.)
| | - Diana Barreira-Hernández
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.).,Department of Biomedical Sciences (Pharmacology Sector), School of Medicine, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.)
| | - Laura Izquierdo-Esteban
- Stroke Unit, Department of Neurology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain (L.I.-E.)
| | - Miguel Gil
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices, Madrid, Spain (M.G., D.G.-B.)
| | - Diana González-Bermejo
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices, Madrid, Spain (M.G., D.G.-B.)
| | - Encarnación Fernández-Antón
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.).,Department of Biomedical Sciences (Pharmacology Sector), School of Medicine, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.)
| | - Antonio Rodríguez-Miguel
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.).,Department of Biomedical Sciences (Pharmacology Sector), School of Medicine, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.)
| | - Alberto García-Lledó
- Department of Cardiology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain (A.G.-L.).,Department of Medicine, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain (A.G.-L.)
| | - Francisco Bolúmar
- Unit of Epidemiology and Public Health. School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain (R.A.-F., F.B.).,Department of Epidemiology and Biostatistics, Graduate School of Public Health, City University of New York (F.B.).,CIBERESP, Spain (F.B.)
| | - Francisco J de Abajo
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.).,Department of Biomedical Sciences (Pharmacology Sector), School of Medicine, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.)
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11
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Meng Q, Huang L, Tao K, Liu Y, Jing J, Wang W, Qin H, Feng D, Cai Q. Integrated Genetics and Micronutrient Data to Inform the Causal Association Between Serum Calcium Levels and Ischemic Stroke. Front Cell Dev Biol 2020; 8:590903. [PMID: 33262986 PMCID: PMC7686510 DOI: 10.3389/fcell.2020.590903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/07/2020] [Indexed: 11/23/2022] Open
Abstract
There has been an increased interest for observational studies or randomized controlled trials exploring the impact of calcium intake on cardiovascular diseases (CVD) including coronary artery disease (CAD) and ischemic stroke (IS). However, a direct relationship between total calcium intake and CVD has not been well established and remains controversial. Mendelian randomization (MR) studies have been performed to evaluate the causal association between serum calcium levels and CAD risk and found that increased serum calcium levels could increase the risk of CAD. However, MR analysis found no significant association between genetically higher serum calcium levels and IS as well as its subtypes. Hence, three MR studies reported inconsistent effects of serum calcium levels on CAD and IS. Here, we performed an updated MR study to investigate the association of serum calcium levels with the risk of IS using large-scale genome-wide association study (GWAS) datasets. We selected 14 independent genetic variants as the potential instrumental variables from a large-scale serum calcium GWAS dataset and extracted summary statistics corresponding to the 14 serum calcium genetic variants from the MEGASTROKE Consortium IS GWAS dataset. Interestingly, we found a significant association between serum calcium levels and IS risk using the robust inverse-variance weighted (IVW) and penalized robust IVW methods, with β = 0.243 and P = 0.002. Importantly, the MR results from the robust MR-Egger and penalized robust MR-Egger methods further supported the causal association between serum calcium levels and IS risk, with β = 0.256 and P = 0.005. Meanwhile, the estimates from other MR methods are also consistent with the above findings.
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Affiliation(s)
- Qiang Meng
- Department of Neurosurgery and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Lu Huang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kai Tao
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yong Liu
- Department of Neurosurgery and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jiangpeng Jing
- Department of Neurosurgery and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Wen Wang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Huaizhou Qin
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dayun Feng
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qing Cai
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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12
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Yarlagadda K, Ma N, Doré S. Vitamin D and Stroke: Effects on Incidence, Severity, and Outcome and the Potential Benefits of Supplementation. Front Neurol 2020; 11:384. [PMID: 32587562 PMCID: PMC7298071 DOI: 10.3389/fneur.2020.00384] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/16/2020] [Indexed: 12/12/2022] Open
Abstract
Vitamin D serum level has been positively associated with improved cardiovascular health, especially with reduction of stroke risk. This systemic review summarizes and synthesizes findings from studies relevant to the relationship between vitamin D and stroke risk, severity, and outcome; potential mechanisms explaining such a relationship; and outcomes from vitamin D supplementation. The literature shows that vitamin D deficiency is a significant risk factor for ischemic stroke, with sun exposure, sex, age, race, diabetes, and genetics playing a role as well. Stroke severity and short- and long-term outcomes also worsen with vitamin D deficiency. The neuroprotective mechanisms by which vitamin D operates to mitigate stroke onset and outcomes have yet to be fully studied, but researchers have proposed several pathways, including promotion of certain neuroprotective growth factors, reduction of arterial pressure through vasodilation, and inhibition of reactive oxygen species. There is some evidence that vitamin D supplementation could lower stroke risk and improve recovery, though outcomes can also be negligible or negative. Although results are mixed and the limitations of vitamin D supplementation merit some caution, vitamin D overall plays a significant role in stroke health. Future research should further develop understanding of the neuroprotective mechanisms of vitamin D and study how supplementation could be administered effectively in stroke treatment.
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Affiliation(s)
- Keerthi Yarlagadda
- Doré Lab, Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, United States
| | - Nicholas Ma
- Doré Lab, Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, United States
| | - Sylvain Doré
- Doré Lab, Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, United States
- Doré Lab, Departments of Neurology, Psychiatry, Pharmaceutics, Psychology, and Neuroscience, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, United States
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13
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Maciá-Martínez MA, Gil M, Huerta C, Martín-Merino E, Álvarez A, Bryant V, Montero D. Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP): A data resource for pharmacoepidemiology in Spain. Pharmacoepidemiol Drug Saf 2020; 29:1236-1245. [PMID: 32337840 DOI: 10.1002/pds.5006] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/05/2020] [Accepted: 03/29/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP) is a population based database administered by the AEMPS (Spanish Agency for Medicines) of longitudinal electronic medical records (EMR) of patients attended in primary care. Its main purpose is to serve as source of information for independent studies on drug safety and support of medicines regulation activities. This article aim is to describe the characteristics of BIFAP, how to access the database and a summary of its potential for research. METHODS Health problems are registered by primary care physicians as episodes of care and include socio-demographic data, results of diagnostic procedures, lifestyle data, general data, and interventions. A proportion of data on hospitalizations and specialist care are currently available through linkage with other data sources. EMRs of the Spanish healthcare system are provided by the regional administrations. Specific data extraction and standardization processes are performed. RESULTS BIFAP includes data from 12 million patients starting in 2001 and updated annually. Validation of drug and diagnosis definitions has been ascertained. Participation in international collaborative projects and a number of articles in peer reviewed journals reflect its contribution to the knowledge of the risks associated with medicines and drug utilization patterns. CONCLUSIONS BIFAP is a useful tool for generating scientific evidence on medicines related issues, helping regulatory decision making in Europe. The main strengths of BIFAP are related to large sample size, population-based, longitudinal nature and annual update of data. BIFAP shares common challenges with similar data sources including accurate and efficient identification of health outcomes and of treatment exposure.
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Affiliation(s)
- Miguel-Angel Maciá-Martínez
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Miguel Gil
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Consuelo Huerta
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Elisa Martín-Merino
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Arturo Álvarez
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Verónica Bryant
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Dolores Montero
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
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- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
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14
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Abstract
PURPOSE OF REVIEW Calcium and vitamin D supplementation is widely recommended for prevention of falls and fracture, particularly in the elderly where calcium intakes and vitamin D levels are often inadequate. A number of meta-analyses have questioned the benefits of untargeted or 'holistic' supplementation for falls and fracture, and raised the possibility of adverse cardiovascular effects. This review provides an update on these controversies. RECENT FINDINGS Recent advances have largely centred around new trials of vitamin D and meta-analyses of published trials and observational studies. These articles have identified holistic vitamin D supplementation with or without calcium is unlikely to be an effective primary prevention strategy for falls or fracture. There has also been high-quality evidence that vitamin D, daily or as a bolus, does not reduce the risk of cardiovascular events. SUMMARY The benefits of vitamin D and calcium supplements for holistic fall and fracture prevention remain uncertain. Recent evidence supports the concept that high-dose vitamin D has adverse musculoskeletal effects. Future studies should focus on moderate daily doses. Finally, there remain inconsistent findings for adverse cardiovascular effects of calcium supplements with or without vitamin D. This uncertainty should be taken into account when evaluating the risk/benefits of supplementation.
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15
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Rodríguez-Martín S, González-Bermejo D, Rodríguez-Miguel A, Barreira D, García-Lledó A, Gil M, de Abajo FJ. Risk of Myocardial Infarction Among New Users of Calcium Supplements Alone or Combined With Vitamin D: A Population-Based Case-Control Study. Clin Pharmacol Ther 2019; 107:359-368. [PMID: 31560413 PMCID: PMC7006888 DOI: 10.1002/cpt.1636] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022]
Abstract
A population‐based case‐control study was conducted to evaluate the risk of acute myocardial infarction among new users of calcium supplements either in monotherapy (CaM) or in combination with vitamin D (CaD). A total of 23,025 cases and 114,851 controls randomly sampled from the underlying cohort and matched with cases by age, sex, and index date were included. New users of CaM and CaD were categorized as current users, recent users, past users, and nonusers. We computed adjusted odds ratios (AORs) and their 95% confidence intervals (CIs) among current users as compared with nonusers through a conditional logistic regression. No increased risk was associated with CaM overall (59 cases (0.26%) and 273 controls (0.24%); AOR = 0.80; 95% CI 0.59–1.09), nor was it found in any of the conditions examined. Instead, the use of CaD was associated with a decreased risk (275 cases (1.19%) and 1,160 controls (1.45%); AOR = 0.78; 95% CI 0.67–0.90), dose and duration‐dependent, and particularly evident in patients with a high cardiovascular risk (AOR = 0.59; 95% CI 0.43–0.81).
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Affiliation(s)
- Sara Rodríguez-Martín
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.,Department of Biomedical Sciences (Pharmacology Sector), University of Alcalá, Alcalá de Henares, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
| | - Diana González-Bermejo
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices, Madrid, Spain
| | - Antonio Rodríguez-Miguel
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.,Department of Biomedical Sciences (Pharmacology Sector), University of Alcalá, Alcalá de Henares, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
| | - Diana Barreira
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.,Department of Biomedical Sciences (Pharmacology Sector), University of Alcalá, Alcalá de Henares, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
| | - Alberto García-Lledó
- Cardiology Department, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.,Department of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Miguel Gil
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices, Madrid, Spain
| | - Francisco J de Abajo
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.,Department of Biomedical Sciences (Pharmacology Sector), University of Alcalá, Alcalá de Henares, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
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Muscogiuri G, Barrea L, Altieri B, Di Somma C, Bhattoa HP, Laudisio D, Duval GT, Pugliese G, Annweiler C, Orio F, Fakhouri H, Savastano S, Colao A. Calcium and Vitamin D Supplementation. Myths and Realities with Regard to Cardiovascular Risk. Curr Vasc Pharmacol 2019; 17:610-617. [DOI: 10.2174/1570161117666190408165805] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 02/09/2019] [Accepted: 02/20/2019] [Indexed: 01/05/2023]
Abstract
Vitamin D and calcium are considered crucial for the treatment of bone diseases. Both vitamin
D and calcium contribute to bone homeostasis but also preserve muscle health by reducing the risk
of falls and fractures. Low vitamin D concentrations result in secondary hyperparathyroidism and contribute
to bone loss, although the development of secondary hyperparathyroidism varies, even in patients
with severe vitamin D deficiency. Findings from observational studies have shown controversial
results regarding the association between bone mineral density and vitamin D/calcium status, thus
sparking a debate regarding optimum concentrations of 25-hydroxyvitamin D and calcium for the best
possible skeletal health. Although most of the intervention studies reported a positive effect of supplementation
with calcium and vitamin D on bone in patients with osteoporosis, this therapeutic approach
has been a matter of debate regarding potential side effects on the cardiovascular (CV) system. Thus, the
aim of this review is to consider the current evidence on the physiological role of vitamin D and calcium
on bone and muscle health. Moreover, we provide an overview on observational and interventional studies
that investigate the effect of vitamin D and calcium supplementation on bone health, also taking into
account the possible CV side-effects. We also provide molecular insights on the effect of calcium plus
vitamin D on the CV system.
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Affiliation(s)
- Giovanna Muscogiuri
- Endocrinology Unit, Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Medical School of Naples, Naples, Italy
| | - Luigi Barrea
- Endocrinology Unit, Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Medical School of Naples, Naples, Italy
| | - Barbara Altieri
- Endocrinology Unit, Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Medical School of Naples, Naples, Italy
| | | | - Harjit pal Bhattoa
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Daniela Laudisio
- Endocrinology Unit, Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Medical School of Naples, Naples, Italy
| | - Guillaume T. Duval
- Department of Geriatric Medicine, University Memory Center, Research Center on Autonomy and Longevity (CeRAL), Angers University Hospital, Angers, France, School of Medicine and UPRES EA 4638, University of Angers, Angers, France
| | - Gabriella Pugliese
- Endocrinology Unit, Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Medical School of Naples, Naples, Italy
| | - Cédric Annweiler
- Department of Geriatric Medicine, University Memory Center, Research Center on Autonomy and Longevity (CeRAL), Angers University Hospital, Angers, France, School of Medicine and UPRES EA 4638, University of Angers, Angers, France
| | - Francesco Orio
- Department of Sports Science and Wellness, "Parthenope" University Naples, Naples, Italy
| | - Hana Fakhouri
- Department of Biochemistry and Molecular Biology, College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Silvia Savastano
- Endocrinology Unit, Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Medical School of Naples, Naples, Italy
| | - Annamaria Colao
- Endocrinology Unit, Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Medical School of Naples, Naples, Italy
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McCarthy MS, Elshaw EB, Szekely BM, Raju D. A Prospective Cohort Study of Vitamin D Supplementation in AD Soldiers: Preliminary Findings. Mil Med 2019; 184:498-505. [PMID: 30901440 DOI: 10.1093/milmed/usy393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/18/2018] [Accepted: 11/19/2018] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To explore response to vitamin D supplementation in active duty (AD) warfighters and translate findings into evidence-based health policy. BACKGROUND Soldiers are at risk for musculoskeletal injuries and metabolic dysfunction that impact physical performance and military readiness; the link with low vitamin D status is unclear. METHODS This prospective trial enrolled 152 soldiers; baseline 25 hydroxyvitamin (OH) D level determined assignment to a no-treatment control (CG) or treatment group (TG) receiving a vitamin D3 supplement for 90 days. Symptoms, diet, sun exposure, and blood biomarkers obtained at baseline (T1) and 3 months (T2). RESULTS Cohort was predominantly white (58%) with a significant difference in racial distribution for vitamin D status. Mean (SD) 25(OH)D levels were 37.8 (5.6) ng/mL, 22.2 (5.0) ng/mL, and 22.9 (4.7) ng/mL for the CG, low dose TG, and high-dose TG at T1, respectively. Following three months of treatment, one-way ANOVA indicated a statistically significant difference between groups (F5,246 = 44.37; p < 0.0001). Vitamin D intake was 44% of Recommended Dietary Allowance throughout the first phase of the trial. Patient-Reported Outcomes Measurement Information System scores improved in TG for fatigue and sleep, p < 0.01. CONCLUSIONS Vitamin D deficiency is widespread in AD soldiers. Clinicians must intervene early in preventable health conditions impacting warfighter performance and readiness and recommend appropriate self-care strategies.
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Affiliation(s)
| | - Evelyn B Elshaw
- The Geneva Foundation, 917 Pacific Ave. Suite 600, Tacoma, WA
| | | | - Dheeraj Raju
- University of Alabama, Birmingham, Birmingham, AL
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Rodríguez-Martín S, Martín-Merino E, Lerma V, Rodríguez-Miguel A, González O, González-Herrada C, Ramírez E, Bellón T, de Abajo FJ. Incidence of Stevens-Johnson syndrome/toxic epidermal necrolysis among new users of different individual drugs in a European population: a case-population study. Eur J Clin Pharmacol 2018; 75:237-246. [PMID: 30298362 DOI: 10.1007/s00228-018-2569-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/27/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE To estimate the specific incidences of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) among new users of drugs frequently reported to be associated with this serious event. METHODS We performed a case-population approach, which combined data from a registry of SJS/TEN cases from the Madrid region (numerator) during the study period 2005-2015 and a primary healthcare database from the same catchment population. The proportion of new users of drugs estimated in the primary healthcare database was stratified by calendar year, sex and age (5-year bands), and then applied to the same strata of Madrid's population census to compute the number of new users (denominator). Incidences were re-estimated using only cases in which the concerned drug had a probable or very probable causal relationship. RESULTS A total of 44 SJS/TEN cases aged > 14 years were registered during the study period. The highest SJS/TEN incidence was found for phenytoin with 68.9 per 100,000 new users (95% CI 27.7-141.9), followed by dexamethasone (5.48; 1.49-14.03), allopurinol (3.29; 1.07-7.67) and cotrimoxazole (3.19; 0.87-8.16). Considering only probable and very probable cases, the incidences hardly changed, except for dexamethasone, which was left without cases. Pantoprazole, levofloxacin and lorazepam showed incidences between 1 per 100,000 and 1 per 1,000,000 new users. Ibuprofen, amoxicillin-clavulanic acid, metamizole, amoxicillin, paracetamol and omeprazole showed incidences around 1 per one million new users. CONCLUSIONS Phenytoin was the drug with the highest incidence of SJS/TEN, followed by allopurinol and cotrimoxazole. For the rest of the drugs, the estimated incidences were below 1 in 100,000 new users.
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Affiliation(s)
- Sara Rodríguez-Martín
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain.,Department of Biomedical Sciences, University of Alcalá, Ctra. Alcalá-Meco s/n, 28805, Alcalá de Henares, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
| | - Elisa Martín-Merino
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices, Madrid, Spain
| | - Victoria Lerma
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
| | - Antonio Rodríguez-Miguel
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain.,Department of Biomedical Sciences, University of Alcalá, Ctra. Alcalá-Meco s/n, 28805, Alcalá de Henares, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
| | - Olga González
- Dermatology Department, University Hospital of Getafe, Getafe, Madrid, Spain
| | | | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital, Madrid, Spain
| | - Teresa Bellón
- Drug Hypersensitivity Laboratory, Institute for Health Research IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Francisco J de Abajo
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain. .,Department of Biomedical Sciences, University of Alcalá, Ctra. Alcalá-Meco s/n, 28805, Alcalá de Henares, Madrid, Spain. .,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain.
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Suntornsaratoon P, Charoenphandhu N, Krishnamra N. Fortified tuna bone powder supplementation increases bone mineral density of lactating rats and their offspring. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2018; 98:2027-2034. [PMID: 28940514 DOI: 10.1002/jsfa.8688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 09/07/2017] [Accepted: 09/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Breastfeeding leads to bone calcium loss for milk production, resulting in progressive maternal osteopenia. Calcium supplement from natural sources has been postulated to be more beneficial to bone health than purified CaCO3 because natural sources also contain other nutrients such as certain amino acids that might enhance calcium metabolism. Herein, we examined the effect of calcium supplementation from tuna bone powder and CaCO3 on bones of dams and the offspring. RESULTS Both forms of calcium supplement, i.e. tuna bone powder and CaCO3 , increased maternal bone mineral density (BMD). However, bone histomorphometry revealed that only tuna bone had beneficial effect on maternal bone microstructure, i.e. increased bone formation, decreased bone resorption and increased in bone volume. Regarding the mechanical properties, the decreased ultimate load in non-supplement lactating mothers was restored to the load seen in nulliparous animals by calcium supplementation. Moreover, both tuna bone and CaCO3 supplementation in mothers led to increased milk calcium concentration and consequently increased BMD in the growing offspring. CONCLUSION Calcium supplement from tuna bone powder was effective in preventing maternal osteopenia. Tuna bone, which is a readily available fishing industrial waste, is a good alternative source of calcium supplement that increases BMD in both lactating mothers and the neonates. © 2017 Society of Chemical Industry.
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Affiliation(s)
- Panan Suntornsaratoon
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand
- Center of Calcium and Bone Research, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Narattaphol Charoenphandhu
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand
- Center of Calcium and Bone Research, Faculty of Science, Mahidol University, Bangkok, Thailand
- Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Nateetip Krishnamra
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand
- Center of Calcium and Bone Research, Faculty of Science, Mahidol University, Bangkok, Thailand
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