1
|
Aleidan FAS. The Cumulative Incidence and Risk Factors of Recurrent Venous Thromboembolism in the Elderly. Vasc Health Risk Manag 2020; 16:437-443. [PMID: 33116554 PMCID: PMC7585262 DOI: 10.2147/vhrm.s264814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background Incidence and outcomes of recurrent venous thromboembolism (VTE) in the elderly are still not fully elucidated. The purpose of this study was to determine the incidence and identify the risk factors of VTE recurrence in this population. Methods A prospective cohort study of a one-year follow-up of 277 patients aged ≥65 years with primary VTE was performed at King Abdulaziz Medical City, a tertiary care teaching hospital in Riyadh, Saudi Arabia. Demographic data, risk factors, and the consequences of VTE (recurrence, bleeding, and mortality) were recorded. Results Of the 277 VTE patients, 39 (14%) were diagnosed with recurrent VTE over a median follow-up period of 12 months. The cumulative incidence of recurrent VTE was 12.75 per hundred patient-year (95% CI, 8.24–17.36). In multivariate Cox regression, malignancy (hazard ratio [HR], 2.87, 95% CI, 1.32–6.24, p=0.008) and surgery (HR 2.78, 95% CI, 1.36–5.67, p=0.005) were identified as independent risk factors for recurrent VTE. Metformin had a significant independent protection effect (HR, 0.16, 95% CI, 0.08–0.33, p<0.001). During follow-up, two patients in the recurrent VTE group and five patients in the group with no recurrent VTE, all of whom were minor bleeding cases, reported no major bleeding. Seven (18%) patients in the recurrent VTE group and nine (4%) patients in the group with no recurrent VTE died (p<0.001). Conclusion The findings of this study show that elderly patients with initial VTE have a recurrent rate (14%), with a cumulative incidence rate of 12.75 per hundred patient-year. Malignancy and surgery were the most important clinical risk factors to impact significantly the development of recurrent VTE in our elderly population. Metformin may have a protective effect against recurrent VTE in the elderly population, and a larger study is needed to validate our findings.
Collapse
Affiliation(s)
- Fahad A S Aleidan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Anticoagulation Clinic, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
2
|
Madsen KS, Kähler P, Kähler LKA, Madsbad S, Gnesin F, Metzendorf M, Richter B, Hemmingsen B. Metformin and second- or third-generation sulphonylurea combination therapy for adults with type 2 diabetes mellitus. Cochrane Database Syst Rev 2019; 4:CD012368. [PMID: 30998259 PMCID: PMC6472662 DOI: 10.1002/14651858.cd012368.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The number of people with type 2 diabetes mellitus (T2DM) is increasing worldwide. The combination of metformin and sulphonylurea (M+S) is a widely used treatment. Whether M+S shows better or worse effects in comparison with other antidiabetic medications for people with T2DM is still controversial. OBJECTIVES To assess the effects of metformin and sulphonylurea (second- or third-generation) combination therapy for adults with type 2 diabetes mellitus. SEARCH METHODS We updated the search of a recent systematic review from the Agency for Healthcare Research and Quality (AHRQ). The updated search included CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and WHO ICTRP. The date of the last search was March 2018. We searched manufacturers' websites and reference lists of included trials, systematic reviews, meta-analyses and health technology assessment reports. We asked investigators of the included trials for information about additional trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) randomising participants 18 years old or more with T2DM to M+S compared with metformin plus another glucose-lowering intervention or metformin monotherapy with a treatment duration of 52 weeks or more. DATA COLLECTION AND ANALYSIS Two review authors read all abstracts and full-text articles and records, assessed risk of bias and extracted outcome data independently. We used a random-effects model to perform meta-analysis, and calculated risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, using 95% confidence intervals (CIs) for effect estimates. We assessed the certainty of the evidence using the GRADE instrument. MAIN RESULTS We included 32 RCTs randomising 28,746 people. Treatment duration ranged between one to four years. We judged none of these trials as low risk of bias for all 'Risk of bias' domains. Most important events per person were all-cause and cardiovascular mortality, serious adverse events (SAE), non-fatal stroke (NFS), non-fatal myocardial infarction (MI) and microvascular complications. Most important comparisons were as follows:Five trials compared M+S (N = 1194) with metformin plus a glucagon-like peptide 1 analogue (N = 1675): all-cause mortality was 11/1057 (1%) versus 11/1537 (0.7%), risk ratio (RR) 1.15 (95% confidence interval (CI) 0.49 to 2.67); 3 trials; 2594 participants; low-certainty evidence; cardiovascular mortality 1/307 (0.3%) versus 1/302 (0.3%), low-certainty evidence; serious adverse events (SAE) 128/1057 (12.1%) versus 194/1537 (12.6%), RR 0.90 (95% CI 0.73 to 1.11); 3 trials; 2594 participants; very low-certainty evidence; non-fatal myocardial infarction (MI) 2/549 (0.4%) versus 6/1026 (0.6%), RR 0.57 (95% CI 0.12 to 2.82); 2 trials; 1575 participants; very low-certainty evidence.Nine trials compared M+S (N = 5414) with metformin plus a dipeptidyl-peptidase 4 inhibitor (N = 6346): all-cause mortality was 33/5387 (0.6%) versus 26/6307 (0.4%), RR 1.32 (95% CI 0.76 to 2.28); 9 trials; 11,694 participants; low-certainty evidence; cardiovascular mortality 11/2989 (0.4%) versus 9/3885 (0.2%), RR 1.54 (95% CI 0.63 to 3.79); 6 trials; 6874 participants; low-certainty evidence; SAE 735/5387 (13.6%) versus 779/6307 (12.4%), RR 1.07 (95% CI 0.97 to 1.18); 9 trials; 11,694 participants; very low-certainty evidence; NFS 14/2098 (0.7%) versus 8/2995 (0.3%), RR 2.21 (95% CI 0.74 to 6.58); 4 trials; 5093 participants; very low-certainty evidence; non-fatal MI 15/2989 (0.5%) versus 13/3885 (0.3%), RR 1.45 (95% CI 0.69 to 3.07); 6 trials; 6874 participants; very low-certainty evidence; one trial in 64 participants reported no microvascular complications were observed (very low-certainty evidence).Eleven trials compared M+S (N = 3626) with metformin plus a thiazolidinedione (N = 3685): all-cause mortality was 123/3300 (3.7%) versus 114/3354 (3.4%), RR 1.09 (95% CI 0.85 to 1.40); 6 trials; 6654 participants; low-certainty evidence; cardiovascular mortality 37/2946 (1.3%) versus 41/2994 (1.4%), RR 0.78 (95% CI 0.36 to 1.67); 4 trials; 5940 participants; low-certainty evidence; SAE 666/3300 (20.2%) versus 671/3354 (20%), RR 1.01 (95% CI 0.93 to 1.11); 6 trials; 6654 participants; very low-certainty evidence; NFS 20/1540 (1.3%) versus 16/1583 (1%), RR 1.29 (95% CI 0.67 to 2.47); P = 0.45; 2 trials; 3123 participants; very low-certainty evidence; non-fatal MI 25/1841 (1.4%) versus 21/1877 (1.1%), RR 1.21 (95% CI 0.68 to 2.14); P = 0.51; 3 trials; 3718 participants; very low-certainty evidence; three trials (3123 participants) reported no microvascular complications (very low-certainty evidence).Three trials compared M+S (N = 462) with metformin plus a glinide (N = 476): one person died in each intervention group (3 trials; 874 participants; low-certainty evidence); no cardiovascular mortality (2 trials; 446 participants; low-certainty evidence); SAE 34/424 (8%) versus 27/450 (6%), RR 1.68 (95% CI 0.54 to 5.21); P = 0.37; 3 trials; 874 participants; low-certainty evidence; no NFS (1 trial; 233 participants; very low-certainty evidence); non-fatal MI 2/215 (0.9%) participants in the M+S group; 2 trials; 446 participants; low-certainty evidence; no microvascular complications (1 trial; 233 participants; low-certainty evidence).Four trials compared M+S (N = 2109) with metformin plus a sodium-glucose co-transporter 2 inhibitor (N = 3032): all-cause mortality was 13/2107 (0.6%) versus 19/3027 (0.6%), RR 0.96 (95% CI 0.44 to 2.09); 4 trials; 5134 participants; very low-certainty evidence; cardiovascular mortality 4/1327 (0.3%) versus 6/2262 (0.3%), RR 1.22 (95% CI 0.33 to 4.41); 3 trials; 3589 participants; very low-certainty evidence; SAE 315/2107 (15.5%) versus 375/3027 (12.4%), RR 1.02 (95% CI 0.76 to 1.37); 4 trials; 5134 participants; very low-certainty evidence; NFS 3/919 (0.3%) versus 7/1856 (0.4%), RR 0.87 (95% CI 0.22 to 3.34); 2 trials; 2775 participants; very low-certainty evidence; non-fatal MI 7/890 (0.8%) versus 8/1374 (0.6%), RR 1.43 (95% CI 0.49 to 4.18; 2 trials); 2264 participants; very low-certainty evidence; amputation of lower extremity 1/437 (0.2%) versus 1/888 (0.1%); very low-certainty evidence.Trials reported more hypoglycaemic episodes with M+S combination compared to all other metformin-antidiabetic agent combinations. Results for M+S versus metformin monotherapy were inconclusive. There were no RCTs comparing M+S with metformin plus insulin. We identified nine ongoing trials and two trials are awaiting assessment. Together these trials will include approximately 16,631 participants. AUTHORS' CONCLUSIONS There is inconclusive evidence whether M+S combination therapy compared with metformin plus another glucose-lowering intervention results in benefit or harm for most patient-important outcomes (mortality, SAEs, macrovascular and microvascular complications) with the exception of hypoglycaemia (more harm for M+S combination). No RCT reported on health-related quality of life.
Collapse
Affiliation(s)
- Kasper S Madsen
- University of CopenhagenFaculty of Health and Medical SciencesBlegdamsvej 3BCopenhagen NDenmark2200
| | - Pernille Kähler
- Faculty of Health and Medical SciencesCopenhagen Medical UniversityBlegdamsvej 3CopenhagenDenmark2100Ø
| | | | - Sten Madsbad
- Hvidovre Hospital, University of CopenhagenDepartment of EndocrinologyHvidovreDenmark
| | - Filip Gnesin
- Department 7652, RigshospitaletDepartment of Endocrinology, Diabetes and MetabolismBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | - Bernd Richter
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | - Bianca Hemmingsen
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | | |
Collapse
|
3
|
Gerstein HC, Ratner RE, Cannon CP, Serruys PW, García-García HM, van Es GA, Kolatkar NS, Kravitz BG, Miller DM, Huang C, Fitzgerald PJ, Nesto RW. Effect of Rosiglitazone on Progression of Coronary Atherosclerosis in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease. Circulation 2010; 121:1176-87. [PMID: 20194881 DOI: 10.1161/circulationaha.109.881003] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hertzel C. Gerstein
- From the McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (H.C.G.); MedStar Research Institute, Washington, DC (R.E.R.); Brigham and Women’s Hospital, Boston, Mass (C.P.C.); Erasmus Medical Center, Rotterdam, the Netherlands (P.W.S.); Cardialysis, Rotterdam, the Netherlands (H.M.G.-G., G.v.E.); GlaxoSmithKline Research and Development, King of Prussia, Pa (N.S.K., B.G.K., D.M.M., C.H.); Stanford University Medical Center, Palo Alto, Calif (P.J.F.); and Lahey Clinic,
| | - Robert E. Ratner
- From the McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (H.C.G.); MedStar Research Institute, Washington, DC (R.E.R.); Brigham and Women’s Hospital, Boston, Mass (C.P.C.); Erasmus Medical Center, Rotterdam, the Netherlands (P.W.S.); Cardialysis, Rotterdam, the Netherlands (H.M.G.-G., G.v.E.); GlaxoSmithKline Research and Development, King of Prussia, Pa (N.S.K., B.G.K., D.M.M., C.H.); Stanford University Medical Center, Palo Alto, Calif (P.J.F.); and Lahey Clinic,
| | - Christopher P. Cannon
- From the McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (H.C.G.); MedStar Research Institute, Washington, DC (R.E.R.); Brigham and Women’s Hospital, Boston, Mass (C.P.C.); Erasmus Medical Center, Rotterdam, the Netherlands (P.W.S.); Cardialysis, Rotterdam, the Netherlands (H.M.G.-G., G.v.E.); GlaxoSmithKline Research and Development, King of Prussia, Pa (N.S.K., B.G.K., D.M.M., C.H.); Stanford University Medical Center, Palo Alto, Calif (P.J.F.); and Lahey Clinic,
| | - Patrick W. Serruys
- From the McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (H.C.G.); MedStar Research Institute, Washington, DC (R.E.R.); Brigham and Women’s Hospital, Boston, Mass (C.P.C.); Erasmus Medical Center, Rotterdam, the Netherlands (P.W.S.); Cardialysis, Rotterdam, the Netherlands (H.M.G.-G., G.v.E.); GlaxoSmithKline Research and Development, King of Prussia, Pa (N.S.K., B.G.K., D.M.M., C.H.); Stanford University Medical Center, Palo Alto, Calif (P.J.F.); and Lahey Clinic,
| | - Héctor M. García-García
- From the McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (H.C.G.); MedStar Research Institute, Washington, DC (R.E.R.); Brigham and Women’s Hospital, Boston, Mass (C.P.C.); Erasmus Medical Center, Rotterdam, the Netherlands (P.W.S.); Cardialysis, Rotterdam, the Netherlands (H.M.G.-G., G.v.E.); GlaxoSmithKline Research and Development, King of Prussia, Pa (N.S.K., B.G.K., D.M.M., C.H.); Stanford University Medical Center, Palo Alto, Calif (P.J.F.); and Lahey Clinic,
| | - Gerrit-Anne van Es
- From the McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (H.C.G.); MedStar Research Institute, Washington, DC (R.E.R.); Brigham and Women’s Hospital, Boston, Mass (C.P.C.); Erasmus Medical Center, Rotterdam, the Netherlands (P.W.S.); Cardialysis, Rotterdam, the Netherlands (H.M.G.-G., G.v.E.); GlaxoSmithKline Research and Development, King of Prussia, Pa (N.S.K., B.G.K., D.M.M., C.H.); Stanford University Medical Center, Palo Alto, Calif (P.J.F.); and Lahey Clinic,
| | - Nikheel S. Kolatkar
- From the McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (H.C.G.); MedStar Research Institute, Washington, DC (R.E.R.); Brigham and Women’s Hospital, Boston, Mass (C.P.C.); Erasmus Medical Center, Rotterdam, the Netherlands (P.W.S.); Cardialysis, Rotterdam, the Netherlands (H.M.G.-G., G.v.E.); GlaxoSmithKline Research and Development, King of Prussia, Pa (N.S.K., B.G.K., D.M.M., C.H.); Stanford University Medical Center, Palo Alto, Calif (P.J.F.); and Lahey Clinic,
| | - Barbara G. Kravitz
- From the McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (H.C.G.); MedStar Research Institute, Washington, DC (R.E.R.); Brigham and Women’s Hospital, Boston, Mass (C.P.C.); Erasmus Medical Center, Rotterdam, the Netherlands (P.W.S.); Cardialysis, Rotterdam, the Netherlands (H.M.G.-G., G.v.E.); GlaxoSmithKline Research and Development, King of Prussia, Pa (N.S.K., B.G.K., D.M.M., C.H.); Stanford University Medical Center, Palo Alto, Calif (P.J.F.); and Lahey Clinic,
| | - Diane M. Miller
- From the McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (H.C.G.); MedStar Research Institute, Washington, DC (R.E.R.); Brigham and Women’s Hospital, Boston, Mass (C.P.C.); Erasmus Medical Center, Rotterdam, the Netherlands (P.W.S.); Cardialysis, Rotterdam, the Netherlands (H.M.G.-G., G.v.E.); GlaxoSmithKline Research and Development, King of Prussia, Pa (N.S.K., B.G.K., D.M.M., C.H.); Stanford University Medical Center, Palo Alto, Calif (P.J.F.); and Lahey Clinic,
| | - Chun Huang
- From the McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (H.C.G.); MedStar Research Institute, Washington, DC (R.E.R.); Brigham and Women’s Hospital, Boston, Mass (C.P.C.); Erasmus Medical Center, Rotterdam, the Netherlands (P.W.S.); Cardialysis, Rotterdam, the Netherlands (H.M.G.-G., G.v.E.); GlaxoSmithKline Research and Development, King of Prussia, Pa (N.S.K., B.G.K., D.M.M., C.H.); Stanford University Medical Center, Palo Alto, Calif (P.J.F.); and Lahey Clinic,
| | - Peter J. Fitzgerald
- From the McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (H.C.G.); MedStar Research Institute, Washington, DC (R.E.R.); Brigham and Women’s Hospital, Boston, Mass (C.P.C.); Erasmus Medical Center, Rotterdam, the Netherlands (P.W.S.); Cardialysis, Rotterdam, the Netherlands (H.M.G.-G., G.v.E.); GlaxoSmithKline Research and Development, King of Prussia, Pa (N.S.K., B.G.K., D.M.M., C.H.); Stanford University Medical Center, Palo Alto, Calif (P.J.F.); and Lahey Clinic,
| | - Richard W. Nesto
- From the McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (H.C.G.); MedStar Research Institute, Washington, DC (R.E.R.); Brigham and Women’s Hospital, Boston, Mass (C.P.C.); Erasmus Medical Center, Rotterdam, the Netherlands (P.W.S.); Cardialysis, Rotterdam, the Netherlands (H.M.G.-G., G.v.E.); GlaxoSmithKline Research and Development, King of Prussia, Pa (N.S.K., B.G.K., D.M.M., C.H.); Stanford University Medical Center, Palo Alto, Calif (P.J.F.); and Lahey Clinic,
| | | |
Collapse
|
11
|
Derosa G, D'Angelo A, Fogari E, Salvadeo S, Gravina A, Ferrari I, Cicero AFG. Effects of nateglinide and glibenclamide on prothrombotic factors in naïve type 2 diabetic patients treated with metformin: a 1-year, double-blind, randomized clinical trial. Intern Med 2007; 46:1837-46. [PMID: 18025765 DOI: 10.2169/internalmedicine.46.0320] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To evaluate the effect on coagulation and fibrinolysis parameters and on non-conventional cardiovascular risk factors of metformin plus nateglinide or glibenclamide in naïve type 2 diabetes patients. PATIENTS AND METHODS A total of 248 type 2 diabetic patients were enrolled and randomly assigned to receive nateglinide or glibenclamide, and metformin for 12 months. We assessed body mass index (BMI), glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), fasting plasma insulin (FPI), postprandial plasma insulin (PPI), homeostasis model assessment index (HOMA index), lipid profile with lipoprotein (a) [Lp(a)], fibrinogen (Fg), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA), homocysteine (Hcy), systolic blood pressure (SBP), diastolic blood pressure (DBP). RESULTS After 9 months of treatment, both tested drug combinations were similarly associated with a significant reduction in FPG (nateglinide, -17.2%; glibenclamide, -16.9%, both p<0.05) compared to the baseline, while HbA1c (-17.3%, p<0.05) and PPG (-15.2%, p<0.05) significantly decreased only in the nateglinide group. After one year of treatment, compared to the baseline the nateglinide group showed a significant reduction in HbA1c (-21%, p<0.01), FPG (-20.7%), p<0.01, PPG (-21.5%, p<0.05), HOMA index (-25.4%, p<0.05); the glibenclamide group, showed a significant reduction in HbA1c (-11%, p<0.05), FPG (-23.2%, p<0.05), PPG (-11.2%, p<0.05), and HOMA index (-23.9%, p<0.05) but to a minor extent. Moreover, the HbA1c difference value from baseline observed in the nateglinide-treated group was significantly higher than that observed in the glibenclamide group. Therefore the nateglinide-treated patients showed a significant reduction in some prothrombotic parameters (PAI-1=-19%, Lp(a)=-31%, and Hcy=-32.3%, all p<0.05), whereas the glibenclamide-treated patients did not. CONCLUSION Nateglinide appears to improve glycemic control as well as the levels of some prothrombotic parameters compared to glibenclamide when administered in combination with metformin.
Collapse
Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Italy.
| | | | | | | | | | | | | |
Collapse
|