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Chen YY, Chang HC, Lin YJ, Chien KL, Hsieh YC, Chung FP, Lin CH, Lip GYH, Chen SA. The impact of sodium-glucose co-transporter-2 inhibitors on dementia and cardiovascular events in diabetic patients with atrial fibrillation. Diabetes Metab Res Rev 2024; 40:e3775. [PMID: 38340046 DOI: 10.1002/dmrr.3775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/28/2023] [Accepted: 12/12/2023] [Indexed: 02/12/2024]
Abstract
AIMS The effectiveness of sodium-glucose co-transporter-2 inhibitors (SGLT2i) on incident dementia in patients with diabetes and atrial fibrillation (AF) remains unknown. This study aimed to investigate the association between SGLT2i and the risk of incident dementia in diabetic patients with AF, and to explore the interactions with oral anticoagulants or dipeptidyl peptidase-4 inhibitors (DPP4i). MATERIALS AND METHODS We conducted a cohort study using Taiwan's National Health Insurance Research Database. Patients with diabetes and AFwithout a prior history of established cardiovascular diseases, were identified. Using propensity score matching, 810 patients receiving SGLT2i were matched with 1620 patients not receiving SGLT2i. The primary outcome was incident dementia, and secondary outcomes included composite cardiovascular events and mortality. RESULTS After up to 5 years of follow-up, SGLT2i use was associated with a significantly lower risk of incident dementia (hazard: 0.71, 95% confidence interval: 0.51-0.98), particularly vascular dementia (HR: 0.44, 95% CI: 0.24-0.82). SGLT2i was related to reduced risks of AF-related hospitalisation (HR: 0.72, 95% CI: 0.56-0.93), stroke (HR: 0.75, 95% CI: 0.60-0.94), and all-cause death (HR: 0.33, 95% CI: 0.24-0.44). The protective effects were consistent irrespective of the concurrent use of non-vitamin K antagonist oral anticoagulants (NOACs) or DPP4i. CONCLUSIONS In diabetic patients with AF, SGLT2i was associated with reduced risks of incident dementia, AF-related hospitalisation, stroke, and all-cause death. The protective effects were independent of either concurrent use of NOACs or DPP4i.
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Affiliation(s)
- Yun-Yu Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine and College of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Hao-Chih Chang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medicine, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Cheng Hsieh
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Shih-Ann Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
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Origa R. Hepatitis C and Thalassemia: A Story with (Almost) a Happy Ending. Pathogens 2023; 12:683. [PMID: 37242353 PMCID: PMC10223616 DOI: 10.3390/pathogens12050683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
Donor screening has nearly eliminated the risk of hepatitis C virus post-transfusion transmission in resource-rich settings. Moreover, the use of direct antiviral agents made it possible to treat the majority of patients with thalassemia and hepatitis C. However, this achievement, while extremely significant, does not erase the effects of the virus in terms of fibrogenesis and mutagenic risk, and adult patients with thalassemia are facing the long-term consequences of the chronic infection both on the liver and extrahepatically. As in the general population, it is in mainly patients with cirrhosis who are increasing in age, even though they are now HCV RNA-negative, who are at risk of hepatocellular carcinoma, which continues to be statistically much more frequent in individuals with than without thalassemia. In certain resource-limited settings, the World Health Organization has estimated that up to 25 percent of blood donations do not undergo screening. It is therefore not surprising that hepatitis virus infection is still the most prevalent in patients with thalassemia worldwide.
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Affiliation(s)
- Raffaella Origa
- Ospedale Pediatrico Microcitemico, Via Jenner Sn, 09121 Cagliari, Italy;
- Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria di Monserrato Strada Provinciale 8, 09042 Cagliari, Italy
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Vaccines and Atrial Fibrillation: A Real-World Pharmacovigilance Study Based on Vaccine Adverse Event Reporting System. Am J Ther 2023; 30:151-153. [PMID: 36892561 DOI: 10.1097/mjt.0000000000001546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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Tai AS, Lin SH. Complete effect decomposition for an arbitrary number of multiple ordered mediators with time-varying confounders: A method for generalized causal multi-mediation analysis. Stat Methods Med Res 2023; 32:100-117. [PMID: 36321187 DOI: 10.1177/09622802221130580] [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: 01/04/2023]
Abstract
Causal mediation analysis is advantageous for mechanism investigation. In settings with multiple causally ordered mediators, path-specific effects have been introduced to specify the effects of certain combinations of mediators. However, most path-specific effects are unidentifiable. An interventional analog of path-specific effects is adapted to address the non-identifiability problem. Moreover, previous studies only focused on cases with two or three mediators due to the complexity of the mediation formula in a large number of mediators. In this study, we provide a generalized definition of traditional path-specific effects and interventional path-specific effects with a recursive formula, along with the required assumptions for nonparametric identification. Subsequently, a general approach is developed with an arbitrary number of multiple ordered mediators and with time-varying confounders. All methods and software proposed in this study contribute to comprehensively decomposing a causal effect confirmed by data science and help disentangling causal mechanisms in the presence of complicated causal structures among multiple mediators.
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Affiliation(s)
- An-Shun Tai
- Department of Statistics, 34912National Cheng Kung University, Tainan
| | - Sheng-Hsuan Lin
- Institute of Statistics, 34914National Yang Ming Chiao Tung University, Hsinchu
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5
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Ruck JM, Zhou AL, Zeiser LB, Alejo D, Durand CM, Massie AB, Segev DL, Bush EL, Kilic A. Trends and three-year outcomes of hepatitis C virus-viremic donor heart transplant for hepatitis C virus-seronegative recipients. JTCVS OPEN 2022; 12:269-279. [PMID: 36590744 PMCID: PMC9801334 DOI: 10.1016/j.xjon.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Objective Heart transplants (HTs) from hepatitis C virus (HCV)-viremic donors to HCV-seronegative recipients (HCV D+/R-) have good 6-month outcomes, but practice uptake and long-term outcomes overall and among candidates on mechanical circulatory support (MCS) have yet to be established. Methods Using the Scientific Registry of Transplant Recipients, we identified US adult HCV-seronegative HT recipients (R-) from 2015 to 2021. We classified donors as HCV-seronegative (D-) or HCV-viremic (D+). We used multivariable regression to compare post-HT extracorporeal membranous oxygenation, dialysis, pacemaker, acute rejection, and risk of post-HT mortality between HCV D+/R- and HCV D-/R-. Models were adjusted for donor, recipient, and transplant characteristics and center HT volume. We performed subgroup analyses of recipients bridged with MCS. Results From 2015 to 2021, the number of HCV D+/R- HT increased from 1 to 181 and the number of centers performing HCV D+/R- HT increased from 1 to 60. Compared with HCV D-/R- recipients, HCV D+/R- versus D-/R- recipients overall and among patients bridged with MCS had similar odds of post-HT extracorporeal membranous oxygenation, dialysis, pacemaker, and acute rejection; and mortality risk at 30 days, 1 year, and 3 years (all P > .05). High center HT volume but not HCV D+/R- volume (<5 vs >5 in any year) was associated with lower mortality for HCV D+/R- HT. Conclusions HCV D+/R- and D-/R- HT have similar outcomes at 3 years' posttransplant. These results underscore the opportunity provided by HCV D+/R- HT, including among the growing population bridged with MCS, and the potential benefit of further expanding use of HCV+ allografts.
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Key Words
- D+, HCV-viremic donor
- DAAs, direct-acting antivirals
- DCD, donation after circulatory death
- D–, HCV-seronegative donor
- ECMO, extracorporeal membranous oxygenation
- HCV, hepatitis C virus
- HT, heart transplant
- IABP, intra-aortic balloon pump
- IQR, interquartile range
- LVAD, left ventricular assist device
- MCS, mechanical circulatory support
- R–, HCV-seronegative recipient
- SRTR, Scientific Registry of Transplant Recipients
- aHR, adjusted hazard ratio
- aOR, adjusted odds ratio
- donor pool
- heart transplant
- hepatitis C
- outcomes
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Affiliation(s)
- Jessica M. Ruck
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Alice L. Zhou
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Laura B. Zeiser
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Diane Alejo
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Christine M. Durand
- Division of Infection Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Allan B. Massie
- Division of Transplant Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Dorry L. Segev
- Division of Transplant Surgery, Department of Surgery, NYU Langone Health, New York, NY,Scientific Registry of Transplant Recipients, Minneapolis, Minn
| | - Errol L. Bush
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md,Address for reprints: Ahmet Kilic, MD, Department of Surgery, Johns Hopkins Medical Institutions, Sheikh Zayed Tower, Suite 7107, 1800 Orleans St, Baltimore, MD 21287.
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Canonico ME, Sanna GD, Siciliano R, Scudiero F, Esposito G, Parodi G. Drug-drug interactions between antithrombotics and direct-acting antivirals in hepatitis C virus (HCV) patients: A brief, updated report. Front Pharmacol 2022; 13:916361. [PMID: 36016569 PMCID: PMC9395984 DOI: 10.3389/fphar.2022.916361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/06/2022] [Indexed: 11/25/2022] Open
Abstract
Hepatitis C virus (HCV) is one of the leading causes of chronic liver disease affecting over 71 million people worldwide. An increased incidence of atherothrombotic events [e.g. coronary artery disease (CAD), atrial fibrillation (AF)] has been observed in HCV seropositive patients. On the other hand, an increased bleeding risk is another clinical issue, particularly in subjects with liver cirrhosis, gastroesophageal varices, portal hypertension, thrombocytopenia and alcohol consumption. The introduction and progressively greater use of direct-acting antivirals (DAAs) (instead of protease and polymerase inhibitors) during the last decade has enabled a sustained virological response to be achieved in a significant percentage of patients. However, due to the high cardiovascular risk profile in HCV-infected patients, the concomitant use of antithrombotic therapies is often required, bearing in mind the possible contraindications. For example, despite better pharmacokinetic and pharmacodynamic properties compared with vitamin K-antagonists, plasma level fluctuations of direct oral anticoagulants (DOACs) due to pathological conditions (e.g. chronic kidney diseases or hepatic cirrhosis) or drug-drug interactions (DDIs) may be of great importance as regards their safety profile and overall clinical benefit. We aimed to examine and briefly summarize the significant DDIs observed between antithrombotic and HCV antiviral drugs.
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Affiliation(s)
| | - Giuseppe Damiano Sanna
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
- *Correspondence: Giuseppe Damiano Sanna,
| | - Roberta Siciliano
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Guido Parodi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
- Department of Cardiology, Ospedali Del Tigullio, Lavagna, Italy
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Drug-Drug Interactions of Direct Oral Anticoagulants (DOACs): From Pharmacological to Clinical Practice. Pharmaceutics 2022; 14:pharmaceutics14061120. [PMID: 35745692 PMCID: PMC9229376 DOI: 10.3390/pharmaceutics14061120] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 12/24/2022] Open
Abstract
The direct oral anticoagulants (DOACs), dabigatran, rivaroxaban, apixaban, and edoxaban, are becoming the most commonly prescribed drugs for preventing ischemic stroke in patients with non-valvular atrial fibrillation (NVAF) and for the treatment and prevention of venous thromboembolism (VTE). Rivaroxaban was also recently approved for the treatment of patients with a recent acute coronary syndrome (ACS). Their use demonstrated to have a favorable risk-benefit profile, with significant reductions in stroke, intracranial hemorrhage, and mortality compared to warfarin, but with increased gastrointestinal bleeding. Nevertheless, their safety profile is compromised in multimorbidity patients requiring contemporary administration of several drugs. Comorbidity and polypharmacy have a high prevalence in elderly patients, who are also more susceptible to bleeding events. The combination of multiple treatments can cause relevant drug–drug interactions (DDIs) by affecting the exposure or the pharmacological activities of DOACs. Although important differences of the pharmacokinetic (PK) properties can be observed between DOACs, all of them are substrate of P-glycoprotein (P-gp) and thus may interact with strong inducers or inhibitors of this drug transporter. On the contrary, rivaroxaban and, to a lower extent, apixaban, are also susceptible to drugs altering the cytochrome P450 isoenzyme (CYP) activities. In the present review, we summarize the potential DDI of DOACs with several classes of drugs that have been reported or have characteristics that may predict clinically significant DDIs when administered together with DOACs. Possible strategies, including dosage reduction, avoiding concomitant administration, or different time of treatment, will be also discussed to reduce the incidence of DDI with DOACs. Considering the available data from specific clinical trials or registries analysis, the use of DOACs is associated with fewer clinically relevant DDIs than warfarin, and their use represents an acceptable clinical choice. Nevertheless, DDIs can be significant in certain patient conditions so a careful evaluation should be made before prescribing a specific DOAC.
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Bagnato G, Imbalzano E, Aragona CO, Ioppolo C, Di Micco P, La Rosa D, Costa F, Micari A, Tomeo S, Zirilli N, Sciacqua A, D’Angelo T, Cacciola I, Bitto A, Irrera N, Russo V, Roberts WN, Gangemi S, Versace AG. New-Onset Atrial Fibrillation and Early Mortality Rate in COVID-19 Patients: Association with IL-6 Serum Levels and Respiratory Distress. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:530. [PMID: 35454369 PMCID: PMC9032834 DOI: 10.3390/medicina58040530] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 01/09/2023]
Abstract
Background and objectives: COVID-19 is associated with an aberrant inflammatory response that may trigger new-onset cardiac arrhythmias. The aim of this study was to assess the mortality risk in hospitalized COVID-19 patients according to IL-6 serum levels and new-onset atrial fibrillation (AF) according to PaO2/FiO2 stratification. Materials and Methods: 175 COVID-19 patients (25 new-onset AF, 22 other types of AF and 128 no-AF) were included in this single-center, retrospective study; clinical and demographic data, vital signs, electrocardiograms and laboratory results were collected and analyzed. The primary outcome of the study was to evaluate the mortality rate in new-onset AF patients according to IL-6 serum levels and PaO2/FiO2 stratification. Results: The incidence of new-onset AF in the study population was 14.2%. Compared to the no-AF group, new-onset AF patients were older with a positive history of chronic kidney disease and heart failure, had higher IL-6, creatinine and urea serum levels whereas their platelet count was reduced. After PaO2/FiO2 stratification, 5-days mortality rate was higher in new-onset AF patients compared to patients with other types of AF and no-AF patients, and mortality risk increases 5.3 fold compared to no-AF (p = 0.0014) and 4.8 fold compared to other forms of AF (p = 0.03). Conclusions: New-onset AF is common in COVID-19 patients and is associated with increased IL-6 serum levels and early mortality. Further studies are needed to support the use of IL-6 as an early molecular target for COVID-19 patients to reduce their high rate of mortality.
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Affiliation(s)
- Gianluca Bagnato
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (C.O.A.); (C.I.); (D.L.R.); (S.T.); (N.Z.); (I.C.); (A.B.); (N.I.); (S.G.); (A.G.V.)
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (C.O.A.); (C.I.); (D.L.R.); (S.T.); (N.Z.); (I.C.); (A.B.); (N.I.); (S.G.); (A.G.V.)
| | - Caterina Oriana Aragona
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (C.O.A.); (C.I.); (D.L.R.); (S.T.); (N.Z.); (I.C.); (A.B.); (N.I.); (S.G.); (A.G.V.)
| | - Carmelo Ioppolo
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (C.O.A.); (C.I.); (D.L.R.); (S.T.); (N.Z.); (I.C.); (A.B.); (N.I.); (S.G.); (A.G.V.)
| | - Pierpaolo Di Micco
- Department of Medicine, Buonconsiglio Fatebenefratelli Hospital, 80122 Naples, Italy;
| | - Daniela La Rosa
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (C.O.A.); (C.I.); (D.L.R.); (S.T.); (N.Z.); (I.C.); (A.B.); (N.I.); (S.G.); (A.G.V.)
| | - Francesco Costa
- BIOMORF Department, University of Messina, 98125 Messina, Italy; (F.C.); (A.M.); (T.D.)
| | - Antonio Micari
- BIOMORF Department, University of Messina, 98125 Messina, Italy; (F.C.); (A.M.); (T.D.)
| | - Simona Tomeo
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (C.O.A.); (C.I.); (D.L.R.); (S.T.); (N.Z.); (I.C.); (A.B.); (N.I.); (S.G.); (A.G.V.)
| | - Natalia Zirilli
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (C.O.A.); (C.I.); (D.L.R.); (S.T.); (N.Z.); (I.C.); (A.B.); (N.I.); (S.G.); (A.G.V.)
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy;
| | - Tommaso D’Angelo
- BIOMORF Department, University of Messina, 98125 Messina, Italy; (F.C.); (A.M.); (T.D.)
| | - Irene Cacciola
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (C.O.A.); (C.I.); (D.L.R.); (S.T.); (N.Z.); (I.C.); (A.B.); (N.I.); (S.G.); (A.G.V.)
| | - Alessandra Bitto
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (C.O.A.); (C.I.); (D.L.R.); (S.T.); (N.Z.); (I.C.); (A.B.); (N.I.); (S.G.); (A.G.V.)
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (C.O.A.); (C.I.); (D.L.R.); (S.T.); (N.Z.); (I.C.); (A.B.); (N.I.); (S.G.); (A.G.V.)
| | - Vincenzo Russo
- Department of Medical Translational Sciences, Division of Cardiology, Monaldi Hospital, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | | | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (C.O.A.); (C.I.); (D.L.R.); (S.T.); (N.Z.); (I.C.); (A.B.); (N.I.); (S.G.); (A.G.V.)
| | - Antonio Giovanni Versace
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (C.O.A.); (C.I.); (D.L.R.); (S.T.); (N.Z.); (I.C.); (A.B.); (N.I.); (S.G.); (A.G.V.)
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9
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Karimi-Sari H, Rezaee-Zavareh MS. Non-atherosclerotic cardiac manifestations of chronic hepatitis C virus infection in the era of direct-acting antiviral agents. Atherosclerosis 2020; 298:70. [PMID: 32147149 DOI: 10.1016/j.atherosclerosis.2020.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Hamidreza Karimi-Sari
- Middle East Liver Diseases (MELD) Center, Tehran, Iran; Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Saeid Rezaee-Zavareh
- Middle East Liver Diseases (MELD) Center, Tehran, Iran; Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran.
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10
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Yang YH, Chiang HJ, Yip HK, Chen KJ, Chiang JY, Lee MS, Sung PH. Risk of New-Onset Atrial Fibrillation Among Asian Chronic Hepatitis C Virus Carriers: A Nationwide Population-Based Cohort Study. J Am Heart Assoc 2019; 8:e012914. [PMID: 31711382 PMCID: PMC6915266 DOI: 10.1161/jaha.119.012914] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Hepatitis C virus (HCV) infection not only links closely to systemic inflammation but also has numerous extrahepatic manifestations. Chronic inflammation also increases the risk of new-onset atrial fibrillation (AF). However, little is known regarding the clinical association between HCV infection and new-onset AF. Methods and Results We conducted a population-based cohort study using Taiwan's National Health Insurance Research Database during 1997 to 2013. A total of 11 771 HCV-infected patients were included in this study, and each of them was matched in a ratio of 1:4. Because of higher mortality among HCV cohorts, we used both Cox proportional hazard regression and competing risk regression models to compute the hazard ratios accompanying 95% CIs after adjustment for relevant confounder. The results demonstrated that the patients with chronic HCV infection had significantly higher incidence rate (332.0 versus 265.8 in 100 000 person-years, P<0.0001) of new-onset AF compared with the non-HCV population. The adjusted hazard ratio of HCV for new-onset AF was 1.32 (95% CI, 1.20-1.44; P<0.0001) and 1.20 (95% CI, 1.10-1.31; P=0.0001) while calculated with Cox proportional hazard regression model and competing risk model, respectively. Intriguingly, we observed that the patients with HCV treated with antiviral agents had significantly lower incidental AF than those without anti-HCV treatment (1.2% versus 6.0%; P<0.0001). Conclusions Chronic HCV infection was associated with an increased risk of incidental AF probably through sharing common pathology of chronic inflammation. Furthermore, a well-designed study is needed to clarify whether anti-HCV therapy can provide protection against the occurrence of AF.
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Affiliation(s)
- Yao-Hsu Yang
- Department of Traditional Chinese Medicine Chang Gung Memorial Hospital, Chiayi Branch Putzu Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi Branch Putzu Taiwan.,School of Medicine Chang Gung University Taoyuan Taiwan
| | - Hsin-Ju Chiang
- Department of Obstetrics and Gynecology College of Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University Kaohsiung Taiwan
| | - Hon-Kan Yip
- Division of Cardiology Department of Internal Medicine College of Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University Kaohsiung Taiwan.,Institute for Translational Research in Biomedicine College of Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University Kaohsiung Taiwan.,Center for Shockwave Medicine and Tissue Engineering Kaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan.,Department of Medical Research China Medical University Hospital China Medical University Taichung Taiwan.,Department of Nursing Asia University Taichung Taiwan
| | - Ko-Jung Chen
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi Branch Putzu Taiwan
| | - John Y Chiang
- Department of Healthcare Administration and Medical Informatics Kaohsiung Medical University Kaohsiung Taiwan.,Department of Computer Science & Engineering National Sun Yat-sen University Kaohsiung Taiwan
| | - Mel S Lee
- Department of Orthopedics College of Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University Kaohsiung Taiwan
| | - Pei-Hsun Sung
- Division of Cardiology Department of Internal Medicine College of Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University Kaohsiung Taiwan.,Center for Shockwave Medicine and Tissue Engineering Kaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan
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