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Barnes EL, Karachalia Sandri A, Herfarth HH, Jess T. Antibiotic Use in the 12 Months Prior to Ileal Pouch-Anal Anastomosis Increases the Risk for Pouchitis. Clin Gastroenterol Hepatol 2024; 22:1678-1686.e8. [PMID: 38556033 PMCID: PMC11272433 DOI: 10.1016/j.cgh.2024.03.012] [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: 09/08/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND & AIMS Pouchitis is the most common complication after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC); however, clinical and environmental risk factors for pouchitis remain poorly understood. We explored the relationship between specific clinical factors and the incidence of pouchitis. METHODS We established a population-based cohort of all adult persons in Denmark undergoing proctocolectomy with IPAA for UC from 1996-2020. We used Cox proportional hazard modeling to assess the impact of antibiotic, nonsteroidal anti-inflammatory drug (NSAID) exposure, and appendectomy on diagnosis of acute pouchitis in the first 2 years after IPAA surgery. RESULTS Among 1616 eligible patients, 46% developed pouchitis in the first 2 years after IPAA. Antibiotic exposure in the 12 months before IPAA was associated with an increased risk of pouchitis (adjusted hazard ratio [aHR], 1.41; 95% confidence interval [CI], 1.22-1.64) after adjusting for anti-tumor necrosis factor alpha use and sex. Compared with persons without any antibiotic prescriptions in the 12 months before IPAA, the risk of pouchitis was increased in those with 1 or 2 courses of antibiotics in that period (aHR, 1.30; 95% CI, 1.11-1.52) and 3 or more courses (aHR, 1.77; 95% CI, 1.41-2.21). NSAID exposure in the 12 months before IPAA and appendectomy were not associated with risk of acute pouchitis (P = .201 and P = .865, respectively). CONCLUSIONS In this population-based cohort study, we demonstrated that antibiotic exposure in the 12 months before IPAA is associated with an increased risk of acute pouchitis. Future prospective studies may isolate specific microbial changes in at-risk patients to drive earlier interventions.
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Affiliation(s)
- Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Anastasia Karachalia Sandri
- Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Hans H Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tine Jess
- Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark; Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
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Boe NJ, Hald SM, Kristensen AR, Möller S, Bojsen JA, Elhakim MT, Rodrigues MA, Al-Shahi Salman R, Hallas J, García Rodríguez LA, Selim M, Goldstein LB, Gaist D. Association of Antithrombotic Drug Use With Incident Intracerebral Hemorrhage Location. Neurology 2024; 102:e209442. [PMID: 38771998 PMCID: PMC11226324 DOI: 10.1212/wnl.0000000000209442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/01/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Few population-based studies have assessed associations between the use of antithrombotic (platelet antiaggregant or anticoagulant) drugs and location-specific risks of spontaneous intracerebral hemorrhage (s-ICH). In this study, we estimated associations between antithrombotic drug use and the risk of lobar vs nonlobar incident s-ICH. METHODS Using Danish nationwide registries, we identified cases in the Southern Denmark Region of first-ever s-ICH in patients aged 50 years or older between 2009 and 2018. Each verified case was classified as lobar or nonlobar s-ICH and matched to controls in the general population by age, sex, and calendar year. Prior antithrombotic use was ascertained from a nationwide prescription registry. We calculated odds ratios (aORs) for associations between the use of clopidogrel, aspirin, direct oral anticoagulants (DOACs) or vitamin K antagonists (VKA), and lobar and nonlobar ICH in conditional logistic regression analyses that were adjusted for potential confounders. RESULTS A total of 1,040 cases of lobar (47.9% men, mean age [SD] 75.2 [10.7] years) and 1,263 cases of nonlobar s-ICH (54.2% men, mean age 73.6 [11.4] years) were matched to 41,651 and 50,574 controls, respectively. A stronger association with lobar s-ICH was found for clopidogrel (cases: 7.6%, controls: 3.5%; aOR 3.46 [95% CI 2.45-4.89]) vs aspirin (cases: 22.9%, controls: 20.4%; aOR 2.14 [1.74-2.63; p = 0.019). Corresponding estimates for nonlobar s-ICH were not different between clopidogrel (cases: 5.4%, controls: 3.4%; aOR 2.44 [1.71-3.49]) and aspirin (cases: 20.7%, controls: 19.2%; aOR 1.77 [1.47-2.15]; p = 0.12). VKA use was associated with higher odds of both lobar (cases: 14.3%, controls: 6.1%; aOR 3.66 [2.78-4.80]) and nonlobar (cases: 15.4%, controls: 5.5%; aOR 4.62 [3.67-5.82]) s-ICH. The association of DOAC use with lobar s-ICH (cases: 3.5%, controls: 2.7%; aOR 1.66 [1.02-2.70]) was weaker than that of VKA use (p = 0.006). Corresponding estimates for nonlobar s-ICH were not different between DOACs (cases: 5.1%, controls: 2.4%; aOR 3.44 [2.33-5.08]) and VKAs (p = 0.20). DISCUSSION Antithrombotics were associated with higher risks of s-ICH, but the strength of the associations varied by s-ICH location and drug, which may reflect differences in the cerebral microangiopathies associated with lobar vs nonlobar hemorrhages and the mechanisms of drug action.
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Affiliation(s)
- Nils Jensen Boe
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Stine Munk Hald
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Alexandra Redzkina Kristensen
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Sören Möller
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Jonas A Bojsen
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Mohammad Talal Elhakim
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Mark A Rodrigues
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Rustam Al-Shahi Salman
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Jesper Hallas
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Luis A García Rodríguez
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Magdy Selim
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Larry B Goldstein
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - David Gaist
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
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Bech-Drewes A, Bonnesen K, Hauge EM, Schmidt M. Cardiovascular safety of using non-steroidal anti-inflammatory drugs for gout: a Danish nationwide case-crossover study. Rheumatol Int 2024; 44:1061-1069. [PMID: 38581450 PMCID: PMC11108875 DOI: 10.1007/s00296-024-05584-7] [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: 01/08/2024] [Accepted: 03/13/2024] [Indexed: 04/08/2024]
Abstract
Gout attacks are treated with uric-lowering and anti-inflammatory drugs. In patients with gout, non-steroidal anti-inflammatory drugs (NSAIDs) could be both cardiovascular beneficial, due to their anti-inflammatory actions, and cardiovascular hazardous, due to their prothrombotic, hypertensive, and proarrhythmic side effects. We, therefore, examined the risk of cardiovascular events associated with NSAID use in patients with gout. We conducted a nationwide, population-based case-crossover study of all Danes ≥ 18 years of age with first-time gout during 1997-2020, who experienced a cardiovascular event (myocardial infarction, ischemic stroke, congestive heart failure, atrial fibrillation/flutter, or cardiovascular death) (n = 59,150). The exposure was use of NSAIDs, overall and according to type (ibuprofen, naproxen, or diclofenac). We used the dates 300, 240, 180, and 120 before the outcome date as reference dates. We used the Mantel-Haenszel method to calculate odds ratios (ORs) with 95% confidence intervals (CIs) of the association between NSAID use and cardiovascular events. NSAID use was overall associated with 12% decreased odds of a cardiovascular event (OR = 0.88, 95% CI: 0.85-0.91). This decreased odds ratio was observed for the use of ibuprofen (OR = 0.92, 95% CI: 0.88-0.97) and naproxen (OR = 0.85, 95% CI: 0.74-0.97), but not for the use of diclofenac (OR = 0.97, 95% CI: 0.90-1.05). Overall, use of NSAIDs was associated with decreased odds of all the individual components of the composite outcome. NSAIDs were not associated with an increased cardiovascular event rate when used in gout patients. Ibuprofen and naproxen appeared to have better cardiovascular risk profiles than diclofenac.
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Affiliation(s)
- Anne Bech-Drewes
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Olof Palmes Allé 43, 8200, Aarhus, Denmark.
| | - Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Olof Palmes Allé 43, 8200, Aarhus, Denmark
| | - Ellen-Magrethe Hauge
- Department of Clinical Medicine, Aarhus University, Olof Palmes Allé 43, 8200, Aarhus, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Olof Palmes Allé 43, 8200, Aarhus, Denmark
- Department of Cardiology, Gødstrup Regional Hospital, Aarhus, Denmark
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Thaarup M, Jacobsen S, Nielsen PB, Nicolajsen CW, Eldrup N, Petersen CN, Behrendt CA, Dahl M, Højen AA, Søgaard M. Adherence and Persistence to Antiplatelet Therapy in Lower Extremity Peripheral Arterial Disease: A Danish Population Based Cohort Study. Eur J Vasc Endovasc Surg 2024; 67:948-957. [PMID: 38341174 DOI: 10.1016/j.ejvs.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Adherence to antiplatelet therapy is recommended but unexplored in patients with symptomatic lower extremity peripheral arterial disease (PAD). Therefore, this study aimed to determine adherence and persistence to antiplatelet therapy in patients with PAD, defined as intermittent claudication and chronic limb threatening ischaemia. DESIGN Population based nationwide cohort study. METHODS This study included all Danish citizens aged ≥ 40 years with a first inpatient or outpatient diagnosis of symptomatic PAD between 2010 - 2017, and who had at least one prescription claim for aspirin and/or clopidogrel within 90 days after diagnosis. Adherence was determined by the proportion of days covered (PDC) during the first year after diagnosis. Persistence was defined as no treatment gap ≥ 30 days between prescription renewals over three year follow up. RESULTS A total of 39 687 patients were eligible for inclusion, of whom 23 279 (58.7%) claimed a prescription for aspirin and/or clopidogrel within 90 days of diagnosis. Among these, 12 898 (55.4%) were prevalent users, while the remainder comprised new users who initiated the therapy after the index PAD diagnosis. The mean PDC was 74.5% (SD 35.0%) for prevalent users and 60.5% (SD 30.5%) for new users. Adherence increased with age and number of concomitant drugs. The overall one year cumulative incidence treatment discontinuation was 13.0% (95% CI 12.5 - 13.4%) overall, 17.2% (CI 16.6 - 17.9%) for prevalent users, and 7.9% (CI 7.4 - 8.4%) for new users. At three year follow up, the cumulative incidence of discontinuation was 31.5% (CI 30.9 - 32.2%) overall, 44.6% (CI 43.7 - 45.4%) for prevalent users, and 14.6% (CI 13.9 - 15.3) for new users. CONCLUSION Less than 60% of patients with newly diagnosed symptomatic PAD claimed a prescription for antiplatelet therapy within 90 days of diagnosis, and both adherence and persistence were moderate during the first year after diagnosis. These findings underscore the importance of efforts to improve the initiation and continuation of antiplatelet therapy in patients with PAD.
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Affiliation(s)
- Maja Thaarup
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Sara Jacobsen
- Danish Centre for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Denmark
| | - Peter Brønnum Nielsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Danish Centre for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Denmark
| | | | - Nikolaj Eldrup
- Department of Vascular Surgery, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | | | - Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany
| | - Marie Dahl
- Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Research Unit of Cardiac, Thoracic, and Vascular Surgery, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Anette Arbjerg Højen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Danish Centre for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Denmark
| | - Mette Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Danish Centre for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Denmark.
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Basem M, Bonnesen K, Pedersen L, Sørensen HT, Schmidt M. Influence of Low-Density Lipoprotein Cholesterol Levels on NSAID-Associated Cardiovascular Risks After Myocardial Infarction: A Population-Based Cohort Study. Clin Epidemiol 2024; 16:281-291. [PMID: 38681781 PMCID: PMC11049159 DOI: 10.2147/clep.s447451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/13/2024] [Indexed: 05/01/2024] Open
Abstract
Aim To examine whether low-density lipoprotein cholesterol (LDL-C) levels influence the cardiovascular risk associated with non-aspirin non-steroidal anti-inflammatory drug (NSAID) use after myocardial infarction (MI). Methods Using Danish health registries, we conducted a population-based cohort study of all adult patients with first-time MI during 2010-2020 with an LDL-C value before discharge. Based on the latest LDL-C value, we categorized patients into a low and a high LDL-C group (<3.0 vs ≥3.0 mmol/L). We used time varying Cox regression to compute hazard ratios (HRs) with 95% confidence intervals of the association between NSAID use and a major adverse cardiovascular event (MACE: recurrent MI, ischemic stroke, and all-cause death). Results We followed 50,573 patients for a median of 3.1 years. While exposed, 521 patients experienced a MACE: 312 in the low LDL-C group and 209 in the high LDL-C group. The HRs for MACE comparing NSAID use with non-use were 1.21 (1.11-1.32) overall, 1.19 (1.06-1.33) in the low LDL-C group, and 1.23 (1.07-1.41) in the high LDL-group. The HRs for recurrent MI and ischemic stroke were comparable between the LDL-C subgroups. The HRs for all-cause death were 1.22 (1.07-1.39) in the low LDL-C group and 1.54 (1.30-1.83) in the high LDL-C group. Changing the cut-off value for LDL-C to 1.8 and 1.4 mmol/L showed consistent results. Conclusion In patients with MI, LDL-C levels did not influence the increased risk of MACE associated with NSAID use, but might influence the association between NSAID use and all-cause death.
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Affiliation(s)
- Mohab Basem
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Gødstrup Regional Hospital, Herning, Denmark
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Dalal RS, Nørgård BM, Zegers FD, Kjeldsen J, Friedman S, Allegretti JR, Lund K. Older Adult-Onset of Inflammatory Bowel Diseases Is Associated With Higher Utilization of Analgesics: A Nationwide Cohort Study. Am J Gastroenterol 2024; 119:323-330. [PMID: 37713526 DOI: 10.14309/ajg.0000000000002497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/25/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Patients with inflammatory bowel diseases (IBD) commonly require analgesic medications to treat pain, which may be associated with complications. We examined trends of analgesic use according to age at IBD onset. METHODS This nationwide cohort study included adults diagnosed with IBD between 1996 and 2021 in Denmark. Patients were stratified according to their age at IBD onset: 18-39 years (young adult), 40-59 years (adult), and older than 60 years (older adult). We examined the proportion of patients who received prescriptions for analgesic medications within 1 year after IBD diagnosis: strong opioids, tramadol, codeine, nonsteroidal anti-inflammatory drugs, and paracetamol. Multivariable logistic regression analysis was performed to examine the association between age at IBD onset and strong opioid prescriptions and the composite of strong opioid/tramadol/codeine prescriptions. RESULTS We identified 54,216 adults with IBD. Among them, 25,184 (46.5%) were young adults, 16,106 (29.7%) were adults, and 12,926 (23.8%) were older adults at IBD onset. Older adults most commonly received analgesic prescriptions of every class. Between 1996 and 2021, strong opioid, tramadol, and codeine prescriptions were stable, while paracetamol prescriptions increased and nonsteroidal anti-inflammatory drug prescriptions decreased. After multivariable logistic regression analysis, older adults had higher adjusted odds of receiving strong opioid prescriptions (adjusted odds ratio 1.95, 95% confidence interval 1.77-2.15) and the composite of strong opioid/tramadol/codeine prescriptions (adjusted odds ratio 1.93, 95% confidence interval 1.81-2.06) within 1 year after IBD diagnosis compared with adults. DISCUSSION In this nationwide cohort, older adults most commonly received analgesic prescriptions within 1 year after IBD diagnosis. Additional research is needed to examine the etiology and sequelae of increased analgesic prescribing to this demographic.
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Affiliation(s)
- Rahul S Dalal
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bente Mertz Nørgård
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Division of Gastroenterolgy and Hepatology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Floor D Zegers
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology S, Odense University Hospital, Odense, Denmark
- Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sonia Friedman
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Division of Gastroenterolgy and Hepatology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jessica R Allegretti
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ken Lund
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Bonnesen K, Pedersen L, Ehrenstein V, Sørensen HT, Lash TL, Schmidt M. Impact of hemoglobin A1c level on the association between non-steroidal anti-inflammatory drug use and cardiovascular events in patients with type 2 diabetes: A population-based cohort study. Pharmacoepidemiol Drug Saf 2023; 32:1233-1243. [PMID: 37294526 DOI: 10.1002/pds.5652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Non-steroidal anti-inflammatory drugs (NSAIDs) should be used cautiously in patients with type 2 diabetes. We examined whether the cardiovascular risks associated with NSAID use depended on HbA1c level in patients with type 2 diabetes. METHODS We conducted a population-based cohort study of all adult Danes with a first-time HbA1c measurement ≥48 mmol/mol during 2012-2020 (n = 103 308). We used information on sex, age, comorbidity burden, and drug use to calculate time-varying inverse probability of treatment weights. After applying these weights in a pooled logistic regression, we estimated hazard ratios (HRs) of the association between use of NSAIDs (ibuprofen, naproxen, or diclofenac) and cardiovascular events (a composite of myocardial infarction, ischemic stroke, congestive heart failure, atrial fibrillation or flutter, and all-cause death). We stratified all analyses by HbA1c level (<53 or ≥53 mmol/mol). RESULTS For ibuprofen use, the HR of a cardiovascular event was 1.53 (95% confidence interval [CI]: 1.34-1.75) in patients with HbA1c <53 and 1.24 (95% CI: 1.00-1.53) in patients with HbA1c ≥53 mmol/mol. For naproxen use, the HR was 1.14 (95% CI: 0.59-2.21) in patients with HbA1c <53 and 1.30 (95% CI: 0.49-3.49) in patients with HbA1c ≥53 mmol/mol. For diclofenac use, the HR was 2.40 (95% CI: 1.62-3.56) in patients with HbA1c <53 and 2.89 (95% CI: 1.65-5.04) in patients with HbA1c ≥53 mmol/mol. CONCLUSIONS In patients with type 2 diabetes, glycemic dysregulation did not affect the cardiovascular risk associated with NSAID use.
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Affiliation(s)
- Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Schmidt M, Hallas J, Ernst MT, Pottegård A. Cardiovascular risks of continuing vs. initiating NSAIDs after first-time myocardial infarction or heart failure: a nationwide cohort study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2023; 9:562-569. [PMID: 37385823 DOI: 10.1093/ehjcvp/pvad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/04/2023] [Accepted: 06/28/2023] [Indexed: 07/01/2023]
Abstract
AIMS It is unknown whether the cardiovascular risks associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) shortly after first-time myocardial infarction (MI) or heart failure (HF) differ between patients continuing and initiating use. METHODS AND RESULTS Using nationwide health registries, we conducted a cohort study of all patients with first-time MI or HF during 1996-2018 (n = 273 682). NSAID users (n = 97 966) were categorized as continuing (17%) and initiating (83%) users according to prescription fillings < 60 days before index diagnosis. The primary outcome was a composite of new MI, HF admission, and all-cause death. Follow-up started 30 days after the index discharge date. We used Cox regression to compute hazard ratios (HRs) with 95% confidence intervals (CIs) comparing NSAID users vs. non-users. The most commonly filled NSAIDs were ibuprofen (50%), diclofenac (20%), etodolac (8.5%), and naproxen (4.3%). The composite outcome HR of 1.25 (CI: 1.23-1.27) was driven by initiators (HR = 1.39, 1.36-1.41) and not continuing users (HR = 1.03, 1.00-1.07). The lack of association among continuing users was also observed for individual NSAIDs (ibuprofen and naproxen), except diclofenac (HR = 1.11, 95% CI: 1.05-1.18). Among initiators, the HR was 1.63 (CI: 1.57-1.69) for diclofenac, 1.31 (CI: 1.27-1.35) for ibuprofen, and 1.19 (CI: 1.08-1.31) for naproxen. The results were consistent for both MI and HF patients, the individual components of the composite outcome, and various sensitivity analyses. CONCLUSION NSAID initiators were more susceptible to adverse cardiovascular outcomes after first-time MI or HF than continuing users.
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Affiliation(s)
- Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Jesper Hallas
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, 5000 Odense C, Denmark
| | - Martin Thomsen Ernst
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, 5000 Odense C, Denmark
| | - Anton Pottegård
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, 5000 Odense C, Denmark
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Bonnesen K, Pedersen L, Ehrenstein V, Grønkjær MS, Sørensen HT, Hallas J, Lash TL, Schmidt M. Impact of Lifestyle and Socioeconomic Position on the Association Between Non-steroidal Anti-inflammatory Drug Use and Major Adverse Cardiovascular Events: A Case-Crossover Study. Drug Saf 2023; 46:533-543. [PMID: 37131013 DOI: 10.1007/s40264-023-01298-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION It is unknown whether the cardiovascular risks associated with non-steroidal anti-inflammatory drug (NSAID) use differ according to lifestyle and socioeconomic position. OBJECTIVE We examined the association between NSAID use and major adverse cardiovascular events (MACE) within subgroups defined by lifestyle and socioeconomic position. METHODS We conducted a case-crossover study of all adult first-time respondents to the Danish National Health Surveys of 2010, 2013, or 2017, without previous cardiovascular disease, who experienced a MACE from survey completion through 2020. We used a Mantel-Haenszel method to obtain odds ratios (ORs) of the association between NSAID use (ibuprofen, naproxen, or diclofenac) and MACE (myocardial infarction, ischemic stroke, heart failure, or all-cause death). We identified NSAID use and MACE via nationwide Danish health registries. We stratified the analyses by body mass index, smoking status, alcohol consumption, physical activity level, marital status, education, income, and employment. RESULTS Compared with non-use, the OR of MACE was 1.34 (95% confidence interval: 1.23-1.46) for ibuprofen, 1.48 (1.04-2.43) for naproxen, and 2.18 (1.72-2.78) for diclofenac. When comparing NSAID use with non-use or the individual NSAIDs with each other, we observed no notable heterogeneity in the ORs within subgroups of lifestyle and socioeconomic position for any NSAID. Compared with ibuprofen, diclofenac was associated with increased risk of MACE in several subgroups with high cardiovascular risk, e.g., individuals with overweight (OR 1.52, 1.01-2.39) and smokers (OR 1.54, 0.96-2.46). CONCLUSIONS The relative increase in cardiovascular risk associated with NSAID use was not modified by lifestyle or socioeconomic position.
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Affiliation(s)
- Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Marie Stjerne Grønkjær
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Jesper Hallas
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Timothy Lee Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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10
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Bonnesen K, Ehrenstein V, Grønkjaer MS, Pedersen L, Lash TL, Schmidt M. Impact of lifestyle and socioeconomic position on use of non-steroidal anti-inflammatory drugs: A population-based cohort study. Pharmacoepidemiol Drug Saf 2023; 32:455-467. [PMID: 36382802 DOI: 10.1002/pds.5571] [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: 07/07/2022] [Revised: 10/10/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Lifestyle and socioeconomic position may confound the link between non-steroidal anti-inflammatory drugs (NSAIDs) and cardiovascular events, if associated with NSAID use. We examined this association. METHODS We conducted a cohort study of all adult first-time responders to the Danish National Health Surveys of 2010, 2013, or 2017 without an NSAID prescription within 3 months before survey completion (n = 407 395). Study exposures were weight, smoking status, alcohol consumption, binge drinking frequency, physical activity level, marital status, highest achieved level of education, income, and employment status. We used a Cox model to compute hazard ratios of time to first redemption of an NSAID prescription and a cumulative odds model to compute odds ratios (ORs) of redeeming one additional NSAID prescription in the year after survey completion. RESULTS Total follow-up time was 1 931 902 years. The odds of redeeming one additional NSAID prescription in the year after survey completion varied within all categories of lifestyle and socioeconomic position. The largest ORs were observed within categories of weight (1.70, 95% CI: 1.65-1.74 for obesity vs. normal weight), smoking status (1.24, 95% CI: 1.21-1.27 for current vs. never use), and education (1.44, 95% CI: 1.39-1.49 for primary or other vs. university or higher education). The Cox model showed consistent results. CONCLUSIONS Markers of unhealthy lifestyle and low socioeconomic position were associated with initiation and prolonged NSAID use. Consideration of lifestyle and socioeconomic markers as potential confounders in NSAID studies is therefore recommended.
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Affiliation(s)
- Kasper Bonnesen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Marie S Grønkjaer
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Morten Schmidt
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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11
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Enevoldsen FC, Christiansen CF, Jensen SK. Twenty-Three-Year Trends in the Use of Potentially Nephrotoxic Drugs in Denmark. Clin Epidemiol 2023; 15:275-287. [PMID: 36915868 PMCID: PMC10008004 DOI: 10.2147/clep.s397415] [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: 11/13/2022] [Accepted: 02/19/2023] [Indexed: 03/09/2023] Open
Abstract
Background The occurrence of acute and chronic kidney diseases has been rising in the last decades. Although drug use is a common risk factor for impaired kidney function, changes in utilization of potential nephrotoxic drugs have received little attention. Purpose To describe temporal trends in the utilization of potentially nephrotoxic drugs in Denmark between 1999 and 2021. Methods Specific drugs known or suspected to be nephrotoxic were identified in the literature. Data on the sold defined daily doses (DDDs) of potentially nephrotoxic drugs between 1999 and 2021 were retrieved using the Danish Register of Medical Product Statistics. Trends in sales of DDDs per 1000 inhabitants per day were tabulated and illustrated graphically. Results From 1999 to 2021, the total sale of all selected drugs increased from 286 to 457 DDDs per 1000 inhabitants per day. The overall sale reached a preliminary peak in 2012 with 449 DDDs per 1000 inhabitants per day and remained relatively stable thereafter until reaching an all-time high in 2021 with 457 DDDs per 1000 inhabitants per day. Contributing with the majority in volume, sales of drugs inhibiting the renin-angiotensin-aldosterone system (RAAS) increased dramatically throughout the period. The same was observed for acetaminophen, methotrexate, tacrolimus, and iodinated contrast dye. In contrast, the sales of diuretics, acetylsalicylic acid, and ciclosporin decreased during the last decade of the study period. Conclusion From 1999-2021 considerable changes in sales of potentially nephrotoxic drugs were observed. In general, the sales increased, in volume predominated by RAAS inhibiting drugs. This increase in sales of potential nephrotoxins could contribute to an increasing occurrence of kidney diseases.
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Affiliation(s)
| | - Christian Fynbo Christiansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Simon Kok Jensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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12
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Bedene A, Dahan A, Rosendaal FR, van Dorp ELA. Opioid epidemic: lessons learned and updated recommendations for misuse involving prescription versus non-prescription opioids. Expert Rev Clin Pharmacol 2022; 15:1081-1094. [PMID: 36068971 DOI: 10.1080/17512433.2022.2114898] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In the past decades, the opioid crisis has heavily impacted parts of the US society and has been followed by an increase in the use of opioids worldwide. It is of paramount importance that we explore the origins of the US opioid epidemic to develop best practices to tackle the rising tide of opioid overdoses. AREAS COVERED In this expert review, we discuss opioid (over)prescription, change in perception of pain, and false advertisement of opioid safety as the leading causes of the US opioid epidemic. Then, we review the evidence about opioid dependence and addiction potential and provide current knowledge about predictors of aberrant opioid-related behavior. Lastly, we discuss different approaches that were considered or undertaken to combat the rising tide of opioid-related deaths by regulatory bodies, pharmaceutical companies, and health-care professionals. For this expert review, we considered published articles relevant to the topic under investigation that we retrieved from Medline or Google scholar electronic database. EXPERT OPINION The opioid epidemic is a dynamic process with many underlying mechanisms. Therefore, no single approach may be best suited to combat it. In our opinion, the best way forward is to employ multiple strategies to tackle different underlying mechanisms.
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Affiliation(s)
- Ajda Bedene
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eveline L A van Dorp
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
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13
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Cardiovascular Risks of Diclofenac Versus Other Older COX-2 Inhibitors (Meloxicam and Etodolac) and Newer COX-2 Inhibitors (Celecoxib and Etoricoxib): A Series of Nationwide Emulated Trials. Drug Saf 2022; 45:983-994. [PMID: 35909207 DOI: 10.1007/s40264-022-01211-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Diclofenac has increased cardiovascular risks, but its risk profile compared with other COX-2 inhibitors remains unknown. AIMS The aim of this study was to compare the cardiovascular risks of diclofenac versus other older and newer COX-2 inhibitors (coxibs). METHODS Using Danish nationwide health registries (1999-2020), we conducted a series of emulated trials (n = 264). Eligible adults had no recent NSAID prescriptions, contraindications or conditions with low adherence. We included initiators of diclofenac (n = 1,600,202), meloxicam (n = 10,903), etodolac (n = 238,538), celecoxib (n = 77,591), and etoricoxib (n = 12,122). We computed the adjusted intention-to-treat incidence rate ratio (aIRR) with 95% confidence interval (CI) of major adverse cardiovascular events (MACE) within 30 days of initiation (5562 events). RESULTS MACE was 20% increased among initiators of diclofenac compared with other older COX-2 inhibitors (aIRR 1.19, 95% CI 1.10-1.28), driven by cardiac death (aIRR 1.57, 95% CI 1.21-2.03). The effect appeared strongest for women (aIRR 1.28, 95% CI 1.15-1.43), individuals with high baseline cardiovascular risk (aIRR 1.32, 95% CI 1.05-1.66), and when comparing high-dose diclofenac with low doses of the other older COX-2 inhibitors (aIRR 1.31, 95% CI 1.13-1.52). The results reflected increased rates compared with both meloxicam (aIRR 1.46, 95% CI 0.94-2.26) and etodolac (aIRR 1.18, 95% CI 1.09-1.28). Diclofenac initiators had similar increased rates of MACE compared with coxibs (aIRR 0.96, 95% CI 0.85-1.08), consistent for celecoxib (aIRR 1.02, 95% CI 0.88-1.19) and etoricoxib (aIRR 0.85, 95% CI 0.66-1.10). CONCLUSIONS The increased cardiovascular risks associated with diclofenac initiation were higher than for other older COX-2 inhibitors (meloxicam/etodolac) and comparable to coxibs (celecoxib/etoricoxib).
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14
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Kurt G, Nagy D, Troelsen FS, Skajaa N, Erichsen R, Farkas DK, Sørensen HT. Venous Thromboembolism and Risk of Cancer in Users of Low-Dose Aspirin: A Danish Population-Based Cohort Study. TH OPEN 2022; 6:e257-e266. [PMID: 36299805 PMCID: PMC9467693 DOI: 10.1055/s-0042-1755606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background
Aspirin may reduce the risk of cancer, particularly gastrointestinal cancer, and venous thromboembolism (VTE). VTE can be the first symptom of occult cancer, but whether it is also a marker of occult cancer in aspirin users remains unknown. Therefore, we investigated the risk of cancer subsequent to VTE among users of low-dose aspirin.
Methods
We conducted a population-based cohort study using data from Danish health registries for the years 2001 to 2018. We identified all patients with a first-time diagnosis of VTE who also redeemed a prescription for low-dose aspirin (75–150mg) within 90 days prior to the first-time VTE. We categorized aspirin users by the number of prescriptions filled as new users (<5 prescriptions), short-term users (5–19 prescriptions), and long-term users (>19 prescriptions). We computed the absolute cancer risks and standardized incidence ratios (SIRs) for cancer using national cancer incidence rates.
Results
We followed-up 11,759 users of low-dose aspirin with VTE. Long-term users comprised 50% of aspirin users. The 1-year absolute risk of cancer was 6.0% for new users and 6.7% for short-term and long-term users, with corresponding SIRs of 3.3 (95% confidence interval [CI]: 2.8–4.0), 3.2 (95% CI: 2.9–3.7), and 2.8 (95% CI: 2.6–3.2), respectively. After the first year of follow-up, the SIR decreased to 1.2 (95% CI: 1.1–1.4) for new users, 1.1 (95% CI: 1.1–1.3) for short-term users, and 1.1 (95% CI: 1.0–1.2) for long-term users.
Conclusion
VTE may be a harbinger of cancer, even in users of low-dose aspirin, regardless of duration of use.
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Affiliation(s)
- Gencer Kurt
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark
| | - Dávid Nagy
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark
| | - Frederikke S. Troelsen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark
| | - Nils Skajaa
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark
| | - Dóra K. Farkas
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark
| | - Henrik T. Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark
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Nicolajsen CW, Søgaard M, Eldrup N, Jensen M, Larsen TB, Goldhaber SZ, Nielsen PB. Temporal trends in abdominal aortic aneurysmal disease: a nationwide cohort study on cardiovascular morbidity and medical cardioprotective therapy. Eur J Prev Cardiol 2022; 29:1957-1964. [DOI: 10.1093/eurjpc/zwac105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/27/2022] [Accepted: 05/17/2022] [Indexed: 01/04/2023]
Abstract
Abstract
Aims
Abdominal aortic aneurysmal disease is associated with increased risk of cardiovascular morbidity and death, which potentially can be reduced with cardioprotective medical therapy. The aim of this study was to observe temporal trends in prevalence and incidence of cardiovascular comorbidity as well as use of medical cardioprotective treatment in patients diagnosed with abdominal aortic aneurysmal disease.
Methods and results
This was a population-based cohort study based on data from national health registries, including all patients diagnosed with abdominal aortic aneurysms between 1998 and 2018. Data were stratified into four time periods (1999–2003, 2004–2008, 2009–2013, and 2014–2018) to illustrate trends over time. Outcome measures were (i) cardiovascular comorbidity and medical cardioprotective therapy at time of diagnosis, (ii) new admissions for atherosclerotic cardiovascular disease, and (iii) all-cause mortality after 2-year follow-up. The study cohort included 33 296 individuals. Mean age was 74 years. Prevalence of atherosclerotic cardiovascular comorbidity at diagnosis decreased from 41.5 to 32.6%. Use of statins increased from 17.9 to 66.9%, antiplatelets from 45.6 to 63.3%, and combined therapy with both antiplatelets and statins from 11.3 to 44.8%, and from 12.1 to 50.7% when anticoagulant therapy was included. Developments in medication use plateaued after 2013. Prevalence and incidence of atherosclerotic cardiovascular disease decreased through all four time periods. The same applied to all-cause mortality, which decreased from 24.3 to 12.4 deaths (per 100 person-years).
Conclusion
In patients diagnosed with abdominal aortic aneurysm, cardiovascular comorbidity at diagnosis, risk of future cardiovascular events, and all-cause mortality is decreasing. Nevertheless, cardiovascular burden and mortality rates remain substantial, and medical cardioprotective therapy can be further improved.
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Affiliation(s)
- Chalotte W. Nicolajsen
- Department of Clinical Medicine, Faculty of Health, Aalborg Thrombosis Research Unit, Aalborg University , Sdr. Skovvej 15, 9000 Aalborg , Denmark
- Department of Cardiology, Aalborg University Hospital , Aalborg , Denmark
| | - Mette Søgaard
- Department of Clinical Medicine, Faculty of Health, Aalborg Thrombosis Research Unit, Aalborg University , Sdr. Skovvej 15, 9000 Aalborg , Denmark
- Department of Cardiology, Aalborg University Hospital , Aalborg , Denmark
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Rigshospitalet , Copenhagen , Denmark
| | - Martin Jensen
- Department of Clinical Medicine, Faculty of Health, Aalborg Thrombosis Research Unit, Aalborg University , Sdr. Skovvej 15, 9000 Aalborg , Denmark
| | - Torben B. Larsen
- Department of Clinical Medicine, Faculty of Health, Aalborg Thrombosis Research Unit, Aalborg University , Sdr. Skovvej 15, 9000 Aalborg , Denmark
- Department of Cardiology, Aalborg University Hospital , Aalborg , Denmark
| | - Samuel Z. Goldhaber
- Thrombosis Research Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital , Boston, MA , USA
- Department of Medicine, Harvard Medical School , Boston, MA , USA
| | - Peter B. Nielsen
- Department of Clinical Medicine, Faculty of Health, Aalborg Thrombosis Research Unit, Aalborg University , Sdr. Skovvej 15, 9000 Aalborg , Denmark
- Department of Cardiology, Aalborg University Hospital , Aalborg , Denmark
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16
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Gaster N, Pedersen L, Ehrenstein V, Böttcher M, Bøtker HE, Sørensen HT, Schmidt M. Cardiovascular risks associated with use of non-steroidal anti-inflammatory drugs in patients with non-obstructive coronary artery disease. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:282-290. [PMID: 34864969 DOI: 10.1093/ehjcvp/pvab082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/30/2021] [Accepted: 12/02/2021] [Indexed: 06/13/2023]
Abstract
AIMS To examine whether non-aspirin non-steroidal anti-inflammatory drug (NSAID) use is associated with increased cardiovascular risks in patients with non-obstructive coronary artery disease (CAD). METHODS AND RESULTS Using Danish medical registries, we conducted a population-based cohort study in Western Denmark during 2008-17. We identified all patients undergoing first-time coronary computed tomography angiography (CCTA) due to suspected CAD (n = 35 399), with results showing no (n = 28 581) or non-obstructive CAD (n = 6818). Multivariate Cox regression was used to compute hazard ratios of major adverse cardiac events (MACEs), including incident myocardial infarction, coronary intervention, and death. The rate of MACE increased by 33% for any NSAID use compared with non-use [hazard ratio 1.33, 95% confidence interval (CI) 1.06-1.68] in patients with no CAD and by 48% (1.48, 95% CI 1.06-2.07) in patients with non-obstructive CAD. Rate difference of MACE, per 100 person-years, was 0.38 (95% CI 0.08-0.67) in patients with no CAD (number needed to harm: 267) and 1.08 (95% CI 0.06-2.11) in patients with non-obstructive CAD (number needed to harm: 92). Current use of older cyclooxygenase-2 inhibitors was associated with the highest hazard ratio in patients with non-obstructive CAD, both when ascertained as pre-CCTA use (2.9-fold increase) and when ascertained from time-varying use (1.8-fold increase). CONCLUSION NSAID use in patients with CCTA-confirmed no and non-obstructive CAD was associated with an increased cardiovascular risk compared with non-use. The absolute risk differences and numbers needed to harm were considered clinically relevant, particularly in patients with non-obstructive CAD.
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Affiliation(s)
- Natascha Gaster
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Aarhus, Denmark
| | - Morten Böttcher
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Aarhus, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Aarhus, Denmark
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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17
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Bonnesen K, Fuglsang CH, Korsgaard S, Lund KH, Gaster N, Ehrenstein V, Schmidt M. Use of Routinely Collected Registry Data for Undergraduate and Postgraduate Medical Education in Denmark. J Eur CME 2021; 10:1990661. [PMID: 34868732 PMCID: PMC8635585 DOI: 10.1080/21614083.2021.1990661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | | | - Søren Korsgaard
- Department of Clinical Epidemiology, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - Katrine Hjuler Lund
- Department of Clinical Epidemiology, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - Natascha Gaster
- Department of Clinical Epidemiology, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University, Aarhus University Hospital, Aarhus, Denmark.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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18
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Würtz M, Olesen KKW, Mortensen MB, Eikelboom JW, Mohammad MA, Erlinge D, Kristensen SD, Maeng M. Dual antithrombotic treatment in chronic coronary syndrome: European Society of Cardiology criteria vs. CHADS-P2A2RC score. Eur Heart J 2021; 43:996-1004. [PMID: 34871376 DOI: 10.1093/eurheartj/ehab785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/28/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS According to the 2019 European Society of Cardiology (ESC) guidelines on chronic coronary syndromes (CCS), adding a P2Y12 inhibitor or rivaroxaban to aspirin should be considered in high-risk patients. We estimated the proportion of patients eligible for treatment with the ESC criteria and examined if a recently validated risk score (CHADS-P2A2RC) could improve risk prediction. METHODS AND RESULTS We included 61 338 CCS patients undergoing first-time coronary angiography in Western Denmark (2003-16) and classified them according to the ESC criteria and the CHADS-P2A2RC score. The ESC criteria identified 33.9% as high risk, 53.3% as moderate risk, and 12.8% as low risk. The CHADS-P2A2RC score identified 24.9% as high risk (≥4 points), 48.1% as moderate risk (2-3 points), and 27.0% as low risk (≤1 points). Major adverse cardiovascular events per 100 person-years were 4.8 [95% confidence interval (CI) 4.6-5.0] in patients considered high risk with both schemes, 2.1 (95% CI 2.0-2.2) in patients considered high risk with the ESC but low-to-moderate risk with the CHADS-P2A2RC criteria, 3.8 (95% CI 3.6-4.1) in patients considered low-to-moderate risk with the ESC but high risk with the CHADS-P2A2RC criteria, and 1.5 (95% CI 1.5-1.6) in patients considered low-to-moderate risk with both schemes. The CHADS-P2A2RC score enabled correct downward risk reclassification of 5161 patients (8%) without events, yielding an improved specificity of 9.7%, a loss of sensitivity of 4.4%, and an overall net reclassification index of 0.053. CONCLUSION Based on the 2019 ESC guidelines, dual antithrombotic treatment should be considered in one-third of CCS patients. The CHADS-P2A2RC score improved risk classification and may particularly identify low-risk patients with limited benefit from treatment.
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Affiliation(s)
- Morten Würtz
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
| | | | - Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
| | - John W Eikelboom
- Population Health Research Institute, Hamilton Health Sciences 237 Barton Street East Hamilton, ON L8L 2X2, Canada, and McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Moman Aladdin Mohammad
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Entregatan 7, Lund 22185, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Entregatan 7, Lund 22185, Sweden
| | - Steen Dalby Kristensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark.,Department of Clinical Medicine, Faculty of Health, Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
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19
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Therkildsen P, de Thurah A, Nielsen BD, Hansen IT, Eldrup N, Nørgaard M, Hauge EM. Increased risk of thoracic aortic complications among patients with giant cell arteritis: a nationwide, population-based cohort study. Rheumatology (Oxford) 2021; 61:2931-2941. [PMID: 34918058 DOI: 10.1093/rheumatology/keab871] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/15/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess the risk of aortic aneurysms (AA), aortic dissections (AD) and peripheral arterial disease (PAD) among patients with GCA. METHODS In this nationwide, population-based cohort study using Danish national health registries, we identified all incident GCA patients ≥50 years between 1996 and 2018 who redeemed three or more prescriptions for prednisolone. Index date was the date of redeeming the third prednisolone prescription. Case definition robustness was checked through sensitivity analysis. We included general population referents matched 1:10 by age, sex and calendar time. Using a pseudo-observation approach, we calculated 5-, 10- and 15-year cumulative incidence proportions (CIP) and relative risks (RR) of AA, AD and PAD with death as a competing risk. RESULTS We included 9908 GCA patients and 98 204 referents. The 15-year CIP of thoracic AA, abdominal AA, AD and PAD in the GCA cohort were 1.9% (95% CI 1.5, 2.2), 1.8% (1.4-2.2), 1.0% (0.7-1.2) and 4.8% (4.2-5.3). Compared with the referents, the 15-year RR were 11.2 (7.41-16.9) for thoracic AA, 6.86 (4.13-11.4) for AD, 1.04 (0.83-1.32) for abdominal AA and 1.53 (1.35-1.74) for PAD. Among GCA patients, female sex, age below 70 years and positive temporal artery findings were risk factors for developing thoracic AA. The median time to thoracic AA was 7.5 years (interquartile range 4.4-11.2) with a number needed to be screened of 250 (167-333), 91 (71-111) and 53 (45-67) after 5, 10 and 15 years. CONCLUSION Patients with GCA have a markedly increased risk of developing thoracic AA and AD, but no increased risk of abdominal AA.
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Affiliation(s)
- Philip Therkildsen
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University, Aarhus
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University, Aarhus
| | | | - Ib Tønder Hansen
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University, Aarhus
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Rigshospitalet, Copenhagen
| | - Mette Nørgaard
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University, Aarhus
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20
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Kirmizi NI, Aydin V, Akici A. Utilization trend of gastric acid-suppressing agents in relation to analgesics. Pharmacoepidemiol Drug Saf 2021; 31:314-321. [PMID: 34738287 DOI: 10.1002/pds.5381] [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: 02/24/2021] [Revised: 10/18/2021] [Accepted: 10/31/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Controversies exist about excessive use of gastric acid-suppressing agents or lack of adequate indications, especially when co-prescribed with analgesics for gastroprotection. We aimed to analyze the nationwide trend of gastric acid-suppressing agents and analgesics. METHODS We obtained nationwide consumption data of analgesics (nonsteroidal anti-inflammatory drugs [NSAIDs], opioids, others) and gastric acid-suppressing agents (proton pump inhibitors [PPI] and histamine-2 receptor antagonists [H2RAs]) between years of 2014-2018 from IQVIA Turkey. Drug utilization was measured by defined daily dose (DDD)/1000 inhabitants/day (DID) unit. Drug sales data were further used to test the correlation of PPIs and H2RAs to analgesics. RESULTS During the study period, analgesic utilization increased from 65.7 to 67.4 DID. NSAIDs constituted 82.7%-84.9% of all analgesic utilization. The consumption of NSAIDs increased by 3.1%, and the most commonly consumed analgesic was diclofenac (18.5 ± 1.5 DID), constituting 25.4%-29.0% of all analgesics. PPI utilization was found to regularly raise from 52.1 DID in 2014 to 72.0 DID in 2018 with an overall increment of 38.2%. Use of H2RAs was found to increase from 11.4 DID in 2014 to 14.0 DID in 2018. The physician visit-adjusted utilization of both antirheumatic NSAIDs and non-antirheumatic analgesics showed significantly moderate-strong positive correlations with PPIs (r: 0.63, 0.48-0.76 and r: 0.63, 0.47-0.75, respectively) and H2RAs (r: 0.61, 0.44-0.73 and r: 0.57, 0.41-0.71, respectively). CONCLUSION The utilization trend exhibited a dramatic increase of the gastric acid-suppressing agents -more pronounced for PPIs, with a modest increase in analgesics. Excessive utilization of PPIs does not seem to imply a tendency toward only NSAID-related gastroprotection.
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Affiliation(s)
- Neriman Ipek Kirmizi
- Department of Medical Pharmacology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Volkan Aydin
- Department of Medical Pharmacology, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Ahmet Akici
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Turkey
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21
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Tajchman DH, Nabi H, Aslam M, Butt JH, Grove EL, Engstrøm T, Holmvang L, Fosbøl EL, Køber L, Sørensen R. Initiation of and persistence with P2Y12 inhibitors in patients with myocardial infarction according to revascularization strategy: a nationwide study. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:774-786. [PMID: 34570197 DOI: 10.1093/ehjacc/zuab043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/24/2021] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND We aimed to analyse initiation of and persistence with P2Y12 inhibitors after first-time myocardial infarction (MI). METHODS AND RESULTS Using Danish nationwide registries, we identified patients ≥30 years with first-time MI during 1 January 2005-30 June 2016 and subsequent prescriptions of P2Y12 inhibitors. Independent factors related to initiation of and persistence with P2Y12 inhibitors were analysed by multivariable logistic regression and a Cox proportional hazards model. Patients were stratified by revascularization strategy: percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), or medical therapy alone (MTA). Overall, 79 597 MI patients were included with 39 172 undergoing PCI, 2619 CABG, and 16 640 MTA, showing initiation of P2Y12 inhibitors of 93.4%, 49.0%, and 51.5%, respectively. Congestive heart failure, cerebrovascular disease, cardiac dysrhythmias, renal failure, previous bleeding, and oral anticoagulants were associated with less initiation of P2Y12 inhibitors. Female sex was associated with less initiation of P2Y12 inhibitors following MTA. MTA, coronary angiography, cerebrovascular disease, diabetes with complications, previous bleeding, antidiabetics, and ticagrelor as P2Y12 inhibitor were associated with non-persistence, whereas female sex, advanced age, and concomitant pharmacotherapy with angiotensin-converting enzyme inhibitors, beta-blockers, statins, oral anticoagulants, and aspirin were associated with high persistence. CONCLUSION Initiation of P2Y12 inhibitors in PCI-treated MI patients was high in contrast to those treated with CABG or MTA and patients with certain comorbidities. Further studies on the benefit-risk ratio of P2Y12 inhibitors in CABG-treated or MTA-treated patients and patients with comorbidities after first-time MI are warranted, as is focus on persistence among patients receiving MTA, patients with comorbidities, and users of ticagrelor.
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Affiliation(s)
- Daniel H Tajchman
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Hafsah Nabi
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mohsin Aslam
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Erik L Grove
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Rikke Sørensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
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22
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de la Cour CD, von Buchwald C, Dehlendorff C, Garset-Zamani M, Grønhøj C, Carlander ALF, Friis S, Kjaer SK. Low-dose aspirin use and mortality risk in patients with head and neck cancer: A nationwide cohort study of 10 770 patients. Int J Cancer 2021; 150:969-975. [PMID: 34536296 DOI: 10.1002/ijc.33814] [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: 06/15/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/05/2022]
Abstract
Several recent observational studies have linked low-dose aspirin use to improved survival in patients with head and neck cancer. However, studies of patterns of aspirin use and risk of cancer-specific mortality are lacking. This nationwide cohort study included all patients in the Danish Cancer Registry with a primary diagnosis of head and neck squamous cell cancer (HNSCC) during 2000 to 2016, aged 30 to 84 years, without prior cancer (except nonmelanoma skin cancer) and alive 1 year after diagnosis. Nationwide registries provided information on filled prescriptions, mortality and potential confounding factors. For a subpopulation, a clinical database provided additional information, including human papillomavirus (HPV) tumor status. We used Cox proportional hazards regression models to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between postdiagnostic low-dose aspirin use (≥1 prescription within first year after diagnosis) and risk of cancer-specific mortality. We identified 10 770 patients with HNSCC during a median follow-up of 3.9 years. Of these, 1799 (16.7%) were low-dose aspirin users. Postdiagnostic use of low-dose aspirin was associated with a HR of 0.97 (95% CI 0.82-1.15) for cancer-specific mortality. Similar neutral associations were found according to patterns of aspirin use. No apparent trends emerged according to age, sex, topography or stage. A tendency towards a decreased cancer-specific mortality risk with low-dose aspirin use was observed among HPV-positive patients; however, the statistical precision was low. In conclusion, we did not observe an association between postdiagnostic low-dose aspirin use and cancer-specific mortality in a nationwide cohort of patients with HNSCC.
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Affiliation(s)
- Cecilie D de la Cour
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Martin Garset-Zamani
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amanda-Louise F Carlander
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren Friis
- Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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23
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Pedersen TGB, Vinter N, Schmidt M, Frost L, Cordsen P, Andersen G, Johnsen SP. Trends in the incidence and mortality of intracerebral hemorrhage, and the associated risk factors, in Denmark from 2004 to 2017. Eur J Neurol 2021; 29:168-177. [PMID: 34528344 DOI: 10.1111/ene.15110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The distribution of the major modifiable risk factors for intracerebral hemorrhage (ICH) changes rapidly. These changes call for contemporary data from large-scale population-based studies. The aim of the present study was to examine trends in incidence, risk factors, and mortality in ICH patients from 2004 to 2017. METHODS In a population-based cohort study, we calculated age- and sex-standardized incidence rates (SIRs), incidence rates (IRs) stratified by age and sex per 100,000 person-years, and trends in risk profiles. We estimated absolute mortality risk, and the Cox proportional hazards regression multivariable-adjusted hazard ratios for 30-day and 1-year mortality. RESULTS We included 16,902 patients (53% men; median age 75 years) from 2004 to 2017. The SIR of ICH decreased from 33 (95% confidence interval [CI] 32-34) in 2004/2005 to 28 (95% CI 27-29) in 2016/2017. Among patients aged ≥70 years, the IR decreased from 137 (95% CI 130-144) in 2004/2005 to 112 (95% CI 106-117) in 2016/2017. The IR in patients aged <70 years was unchanged. From 2004 to 2017, the proportion of patients with hypertension increased from 49% to 66%, the use of oral anticoagulants increased from 7% to 18%, and the use of platelet inhibitors decreased from 40% to 28%. The adjusted hazard ratio for 30-day mortality in 2016/2017 was 0.94 (95% CI 0.89-1.01) and 1-year mortality was 0.98 (95% CI 0.93-1.04) compared with 2004/2005. CONCLUSION The incidence of spontaneous ICH decreased from 2004 to 2017, with no clear trend in mortality. The risk profile of ICH patients changed substantially, with increasing proportions of hypertension and anticoagulant treatment. Given the high mortality rate of ICH, further advances in prevention and treatment are urgently needed.
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Affiliation(s)
- Tine Glavind Bülow Pedersen
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Nicklas Vinter
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Morten Schmidt
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
| | - Lars Frost
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pia Cordsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Grethe Andersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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24
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Use of Primary Care Data in Research and Pharmacovigilance: Eight Scenarios Where Prescription Data are Absent. Drug Saf 2021; 44:1033-1040. [PMID: 34296384 PMCID: PMC8297607 DOI: 10.1007/s40264-021-01093-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 01/06/2023]
Abstract
The use of primary care databases has been integral in pharmacoepidemiological studies and pharmacovigilance. Primary care databases derive from electronic health records and offer a comprehensive description of aggregate patient data, from demography to medication history, and good sample sizes. Studies using these databases improve our understanding of prescribing characteristics and associated risk factors to facilitate better patient care, but there are limitations. We describe eight key scenarios where study data outcomes can be affected by absent prescriptions in UK primary care databases: (1) out-of-hours, urgent care and acute care prescriptions; (2) specialist-only prescriptions; (3) alternative community prescribing, such as pharmacy, family planning clinic or sexual health clinic medication prescriptions; (4) newly licensed medication prescriptions; (5) medications that do not require prescriptions; (6) hospital inpatient and outpatient prescriptions; (7) handwritten prescriptions; and (8) private pharmacy and private doctor prescriptions. The significance of each scenario is dependent on the type of medication under investigation, nature of the study and expected outcome measures. We recommend that all researchers using primary care databases be aware of the potential for missing prescribing data and be sensitive to how this can vary substantially between items, drug classes, patient groups and over time. Close liaison with practising primary care clinicians in the UK is often essential to ensure awareness of nuances in clinical practice.
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25
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Gaster N, Hallas J, Pottegård A, Friis S, Schmidt M. The Validity of Danish Prescription Data to Measure Use of Aspirin and Other Non-Steroidal Anti-Inflammatory Drugs and Quantification of Bias Due to Non-Prescription Drug Use. Clin Epidemiol 2021; 13:569-579. [PMID: 34285591 PMCID: PMC8286082 DOI: 10.2147/clep.s311450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/08/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose To evaluate the potential of Danish prescription registries to capture aspirin and non-aspirin non-steroidal anti-inflammatory drug (NSAID) use and to quantitatively evaluate the magnitude of bias from misclassification of true NSAID and aspirin use as apparent non-use in drug outcome studies. Patients and Methods In a population-based cohort study, we retrieved sales statistics for NSAIDs and aspirins based on nationwide data from the Danish Health Data Authority and the Danish National Prescription Registry. We estimated prevalence of recorded and non-recorded NSAID use in the prescription registry and resulting proportions of true NSAID and aspirin use misclassified as apparent non-use from 1999 to 2019 at population and patient levels. Results The prevalence of true use misclassified as non-use (mainly due to over-the-counter use) peaked at 4.7% in 2012 for NSAIDs overall, 5.5% in 2012 for ibuprofen, and at 5.9% in 2002 for high-dose aspirin. Misclassification of other individual NSAIDs was near null. Misclassification of true low-dose aspirin use as non-use declined during the study period but remained around 1% since 2005. In subgroups of cardiac patients, the highest prevalence of true NSAID use misclassified as non-use was 5.0% in 2002 and 4.3% in 2017. Quantitative bias analyses showed how such misclassification of true NSAID and aspirin use as non-use remained minimal both at population and patient levels. In hypothetical examples simulating real study populations with differing exposure prevalence and prevalence of true NSAID and aspirin use misclassified as apparent non-use, the approximate percentage change due to misclassification of use as non-use did not exceed 5% and in most scenarios stayed around 1%. Conclusion The Danish prescription registries are valid data sources for assessing the effects of aspirin and NSAID use. The influence of non-recorded NSAID and aspirin use on estimates of association is virtually negligible.
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Affiliation(s)
- Natascha Gaster
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Hallas
- Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anton Pottegård
- Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Troelsen FS, Farkas DK, Erichsen R, Sørensen HT. Risk of lower gastrointestinal bleeding and colorectal neoplasms following initiation of low-dose aspirin: a Danish population-based cohort study. BMJ Open Gastroenterol 2021; 7:bmjgast-2020-000453. [PMID: 32719046 PMCID: PMC7389508 DOI: 10.1136/bmjgast-2020-000453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Aspirin may increase the risk of lower gastrointestinal bleeding (LGIB) from precursors of colorectal cancer (CRC). We investigated whether use of low-dose aspirin, through initiation of LGIB, may lead patients to undergo colonoscopy and polypectomy before manifest CRC. DESIGN We conducted a historical cohort study (2005-2013) of all Danish residents who initiated low-dose aspirin treatment (n=412 202) in a setting without screening for CRC. Each new aspirin user was matched with three non-users (n=1 236 560) by age, sex and region of residence on the date of their matched new user's first-time aspirin prescription (index date). We computed absolute risks (ARs), risk differences and relative risks (RRs) of LGIB, lower gastrointestinal endoscopy, colorectal polyps and CRC, comparing aspirin users with non-users. RESULTS The ARs were higher for new users than non-users for LGIB, lower gastrointestinal endoscopy, colorectal polyps and CRC within 3 months after index. Comparing new users with non-users, the RRs were 2.79 (95% CI 2.40 to 3.24) for LGIB, 1.73 (95% CI 1.63 to 1.84) for lower gastrointestinal endoscopy, 1.56 (95% CI 1.42 to 1.72) for colorectal polyps and 1.73 (95% CI 1.51 to 1.98) for CRC. The RRs remained elevated for more than 12 months after the index date, with the exception of CRC where the RRs were slightly decreased during the 3-5 years (RR 0.90, 95% CI 0.83 to 0.98) and more than 5 years (RR 0.91, 95% CI 0.82 to 1.00) following the index date. CONCLUSION These findings indicate that aspirin may contribute to reduce CRC risk by causing premalignant polyps to bleed, thereby expediting colonoscopy and polypectomy before CRC development.
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Affiliation(s)
| | | | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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Bonnesen K, Schmidt M. Re-categorization of non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) according to clinical relevance: Abandoning the ´traditional NSAID´ terminology. Can J Cardiol 2021; 37:1705-1707. [PMID: 34182020 DOI: 10.1016/j.cjca.2021.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022] Open
Abstract
Non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used to treat pain, fever, and inflammation. Historically, NSAIDs have been categorized as traditional NSAIDs and newer cyclooxygenase (COX)-2 inhibitors (coxibs). However, traditional NSAIDs also inhibit the COX-1 and COX-2 enzyme isoforms to a varying degree. This diversity of COX-1 and COX-2 selectivity within the class of traditional NSAIDs has proven clinically important with evidence accumulating on the cardiovascular risks associated with selective COX-2 inhibition. Thus, the relative COX-2 selectivity of traditional NSAIDs correlates with their cardiovascular risk profile, being more favorable for non-selective NSAIDs, such as naproxen and low-dose ibuprofen, and less favorable for more COX-2 selective agents, such as diclofenac. To enhance clinically relevant terminology, we advocate categorizing all non-aspirin NSAIDs- including traditional NSAIDs-according to their relative COX-1 and COX-2 selectivity as either: (1) COX-1 inhibitors, (2) non-selective NSAIDs, or (3) COX-2 inhibitors. We further recommend subcategorizing COX-2 inhibitors as newer COX-2 inhibitors (coxibs) or older COX-2 inhibitors. Finally, we recommend also to examine the effects of the individual NSAIDs included in each of the proposed categories. Adhering to these recommendations will align future studies, advance interpretation of COX-specific adverse cardiovascular effects, and provide better guidance to clinicians prescribing NSAIDs.
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Affiliation(s)
- Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark; Department of Cardiology, Aarhus University Hospital, Denmark
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Sperling CD, Verdoodt F, Aalborg GL, Dehlendorff C, Friis S, Kjaer SK. Non-aspirin NSAID use and mortality of endometrial cancer. A nationwide cohort study. Cancer Causes Control 2021; 32:515-523. [PMID: 33620641 DOI: 10.1007/s10552-021-01402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Laboratory studies have shown anti-neoplastic properties of non-aspirin NSAID; however, no studies have examined the influence of non-aspirin NSAIDs as potential adjuvant cancer therapy in women with endometrial cancer. We therefore examined the association between post-diagnostic use of non-aspirin NSAIDs and endometrial cancer mortality in Denmark. METHODS We identified all women with a primary endometrial cancer diagnosis between 2000 and 2012, who were alive one year after the diagnosis. Information on drug use, cause-specific mortality and potential confounders was obtained from nationwide health- and demographic registries. Cox regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between post-diagnostic non-aspirin NSAID use and endometrial cancer mortality. RESULTS Among 6 694 endometrial cancer patients with a maximum follow-up of 13 years, 753 women died from endometrial cancer. Post-diagnostic non-aspirin NSAID use (≥ 1 filled prescription) was associated with an overall HR of 1.15 (95% CI; 0.97-1.36) for endometrial cancer mortality, with higher HRs for the highest intensity of use (HR; 1.40, 95% CI; 1.11-1.77) and largest cumulative amount (HR; 1.56, 95% CI; 1.14-2.14). CONCLUSION Our findings yielded no evidence that use of non-aspirin NSAIDs was associated with reduced endometrial cancer. Rather, we observed that high-intensity and large cumulative amount of non-aspirin NSAID use may be associated with increased endometrial cancer mortality.
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Affiliation(s)
- Cecilie Dyg Sperling
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
| | - Freija Verdoodt
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Gitte Lerche Aalborg
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, 210, Denmark
| | - Christian Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, 210, Denmark
| | - Søren Friis
- Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjaer
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Prevalence of Colorectal Neoplasms and Mortality in New Users of Low-Dose Aspirin With Lower Gastrointestinal Bleeding. Am J Ther 2021; 28:e19-e29. [PMID: 31356342 DOI: 10.1097/mjt.0000000000001042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Aspirin inhibits platelet function and may therefore accelerate early lower gastrointestinal bleeding (LGIB) from colorectal cancer (CRC) precursor polyps. The bleeding may increase endoscopic polyp detection. STUDY QUESTION To estimate the prevalence of polyps and CRC comparing new users of low-dose aspirin with nonusers who all received a diagnosis of LGIB and to investigate the mortality among these patients. STUDY DESIGN Using Danish nationwide health registries, we conducted a cohort study (2006-2013) of all new aspirin users who also received a diagnosis of LGIB (n = 40,578). Each new user was matched with 5 nonusers with LGIB by gender and age at the LGIB diagnosis date. MEASURES AND OUTCOMES We computed the prevalence and prevalence ratios (PRs) of colorectal polyps and CRCs, and the mortality ratios within 6 months after the LGIB, comparing new users with nonusers. RESULTS We identified 1038 new aspirin users and 5190 nonusers with LGIB. We observed 220 new users and 950 nonusers recorded with endoscopically detected polyps. New aspirin users had a higher prevalence of conventional {PR = 1.28 [95% confidence interval (CI): 1.06-1.55]} and serrated [PR = 1.31 (95% CI: 0.95-1.80)] polyps. New users and nonusers had a similar prevalence of CRC [PR = 1.04 (95% CI: 0.77-1.39)]. However, after stratifying by location of CRC, the prevalence of proximal tumors was lower [PR = 0.71 (95% CI: 0.35-1.43)] in new users than in nonusers. No difference in mortality was observed. CONCLUSIONS These findings indicate that new use of low-dose aspirin is associated with an increased detection of colorectal polyps compared with nonuse.
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Søgaard M, Nielsen PB, Skjøth F, Eldrup N, Larsen TB. Temporal Changes in Secondary Prevention and Cardiovascular Outcomes After Revascularization for Peripheral Arterial Disease in Denmark: A Nationwide Cohort Study. Circulation 2020; 143:907-920. [PMID: 33300375 DOI: 10.1161/circulationaha.120.047994] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with peripheral arterial disease (PAD) are at increased risk of cardiovascular morbidity and mortality. Medical prevention with antithrombotic and statin therapies is a mainstay of treatment to prevent adverse outcomes; nevertheless, patients with PAD are often undertreated. This study describes the temporal changes in medical prevention and adverse outcomes in a national cohort of patients with symptomatic PAD after revascularization. METHODS We identified all patients with a first open surgical or endovascular revascularization procedure in the lower extremities or abdomen in Denmark, from 2000 to 2016. We examined temporal changes in the use of aspirin, clopidogrel, and statins and 1-year cause-specific hazard ratios for adverse clinical outcomes, after adjusting for procedure type, treatment indication, age, sex, and cardiovascular risk factors. The analyses were performed overall and within strata of index procedure (endovascular versus surgical), treatment indication, age, sex, and high-risk comorbidities. RESULTS Between 2000 and 2016, we identified 32 911 patients who underwent revascularization for symptomatic PAD. The mean age was 69 years and increased over time, as did the burden of comorbidity. The cumulative incidence of medication use increased between 2000 to 2004 and 2013 to 2016, respectively, from 57.3% to 64.3% for aspirin, 3.6% to 24.8% for clopidogrel, and 36.2% to 77.1% for statins. Concurrently, the 1-year outcome rates declined. Compared with 2000 to 2004, the adjusted hazard ratios in 2013 to 2016 were 0.73 (95% CI, 0.62-0.84) for major adverse cardiovascular events, 0.92 (95% CI, 0.85-1.00) for major adverse limb events, 0.60 (95% CI, 0.48-0.74) for myocardial infarction, 0.94 (95% CI, 0.75-1.18) for ischemic stroke, 0.92 (95% CI, 0.75-1.12) for major bleeding, 0.54 (95% CI, 0.39-0.76) for cardiovascular death, and 0.80 (95% CI, 0.72-0.88) for all-cause death. These improvements in prognosis were most prominent from 2000 to 2004 to 2005 to 2008 and occurred in all strata of index procedure, treatment indication, sex, age, and comorbidity. In contrast, the adjusted hazard ratio for major amputations was 1.00 (95% CI, 0.90-1.11) when comparing 2013 to 2016 to 2000 to 2004. CONCLUSIONS Medical prevention of adverse events has increased considerably over time in patients who underwent revascularization for symptomatic PAD. This increase was accompanied by reductions in all adverse outcomes, except major amputations.
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Affiliation(s)
- Mette Søgaard
- Department of Cardiology (M.S., P.B.N., T.B.L.), Aalborg University Hospital, Denmark.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Denmark (M.S., P.B.N., F.S., T.B.L.)
| | - Peter Brønnum Nielsen
- Department of Cardiology (M.S., P.B.N., T.B.L.), Aalborg University Hospital, Denmark.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Denmark (M.S., P.B.N., F.S., T.B.L.)
| | - Flemming Skjøth
- Unit for Clinical Biostatistics (F.S.), Aalborg University Hospital, Denmark.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Denmark (M.S., P.B.N., F.S., T.B.L.)
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Copenhagen University, Rigshospitalet, Denmark (N.E.).,Danish Vascular Registry, Danish Regions, Aarhus, Denmark (N.E.)
| | - Torben Bjerregaard Larsen
- Department of Cardiology (M.S., P.B.N., T.B.L.), Aalborg University Hospital, Denmark.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Denmark (M.S., P.B.N., F.S., T.B.L.)
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Sigvardt FL, Hansen ML, Kristensen SL, Gustafsson F, Ghanizada M, Schou M, Køber L, Torp-Pedersen C, Gislason GH, Madelaire C. Risk Factors for Morbidity and Mortality Following Hospitalization for Pericarditis. J Am Coll Cardiol 2020; 76:2623-2631. [DOI: 10.1016/j.jacc.2020.09.607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 02/08/2023]
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Riis AH, Kristensen PK, Petersen MG, Ebdrup NH, Lauritsen SM, Jørgensen MJ. Cohort profile: CROSS-TRACKS: a population-based open cohort across healthcare sectors in Denmark. BMJ Open 2020; 10:e039996. [PMID: 33122323 PMCID: PMC7597526 DOI: 10.1136/bmjopen-2020-039996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This paper describes the open cohort CROSS-TRACKS, which comprises population-based data from primary care, secondary care and national registries to study patient pathways and transitions across sectors while adjusting for sociodemographic characteristics. PARTICIPANTS A total of 221 283 individuals resided in the four Danish municipalities that constituted the catchment area of Horsens Regional Hospital in 2012-2018. A total of 96% of the population used primary care, 35% received at least one transfer payment and 66% was in contact with a hospital at least once in the period. Additional clinical information is available for hospital contacts (eg, alcohol intake, smoking status, body mass index and blood pressure). A total of 23% (n=8191) of individuals aged ≥65 years had at least one potentially preventable hospital admission, and 73% (n=5941) of these individuals had more than one. FINDINGS TO DATE The cohort is currently used for research projects in epidemiology and artificial intelligence. These projects comprise a prediction model for potentially preventable hospital admissions, a clinical decision support system based on artificial intelligence, prevention of medication errors in the transition between sectors, health behaviour and sociodemographic characteristics of men and women prior to fertility treatment, and a recently published study applying machine learning methods for early detection of sepsis. FUTURE PLANS The CROSS-TRACKS cohort will be expanded to comprise the entire Central Denmark Region consisting of 1.3 million residents. The cohort can provide new knowledge on how to best organise interventions across healthcare sectors and prevent potentially preventable hospital admissions. Such knowledge would benefit both the individual citizen and society as a whole.
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Affiliation(s)
- Anders Hammerich Riis
- Department of Research, Horsens Regional Hospital, Horsens, Denmark
- Enversion A/S, Aarhus, Denmark
| | - Pia Kjær Kristensen
- Department of Research, Horsens Regional Hospital, Horsens, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ninna Hinchely Ebdrup
- Department of Research, Horsens Regional Hospital, Horsens, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon Meyer Lauritsen
- Enversion A/S, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Risk of Renal Cell Carcinoma Associated with Calcium Channel Blockers: A Nationwide Observational Study Focusing on Confounding by Indication. Epidemiology 2020; 31:860-871. [PMID: 32897909 DOI: 10.1097/ede.0000000000001256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND We examined whether the apparent association between renal cell carcinoma (RCC) and use of dihydropyridine calcium channel blockers (CCBs) was explained by confounding by indication since hypertension, the main indication for CCBs, is a risk factor for RCC. METHODS Using Danish health registries, we conducted a nested case-control study including 7315 RCC cases during 2000-2015. We matched each case with up to 20 controls on age and sex using risk-set sampling. We estimated odds ratios (ORs) for long-term CCB use associated with RCC using conditional logistic regression. We addressed confounding by indication by (1) adjusting for hypertension severity indicators; (2) evaluating dose-response patterns; (3) examining whether other first-line anti-hypertensives were associated with RCC; and (4) using an active comparator new user design by nesting the study in new users of CCBs or angiotensin-converting enzyme inhibitors (ACEIs). RESULTS The adjusted OR for RCC associated with long-term CCB use compared to non-use was 1.76 (1.63-1.90). After we additionally adjusted for hypertension severity indicators, the OR remained elevated (OR 1.37; confidence interval [CI] 1.25, 1.49) with evidence of a dose-response pattern. Other anti-hypertensives were also associated with RCC, for example, ACEIs (OR 1.27; 95% CI = 1.16, 1.39) and thiazides (OR 1.22; 95% CI = 1.12, 1.34). In the active comparator new user design, the OR was 1.21 (95% CI = 0.95, 1.53) for use of CCBs compared with ACEIs. CONCLUSIONS In this population, confounding by indication appeared to explain at least part of the association between RCC and dihydropyridine CCBs.
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Lund LC, Kristensen KB, Reilev M, Christensen S, Thomsen RW, Christiansen CF, Støvring H, Johansen NB, Brun NC, Hallas J, Pottegård A. Adverse outcomes and mortality in users of non-steroidal anti-inflammatory drugs who tested positive for SARS-CoV-2: A Danish nationwide cohort study. PLoS Med 2020; 17:e1003308. [PMID: 32898149 PMCID: PMC7478808 DOI: 10.1371/journal.pmed.1003308] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/03/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Concerns over the safety of non-steroidal anti-inflammatory drug (NSAID) use during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been raised. We studied whether use of NSAIDs was associated with adverse outcomes and mortality during SARS-CoV-2 infection. METHODS AND FINDINGS We conducted a population-based cohort study using Danish administrative and health registries. We included individuals who tested positive for SARS-CoV-2 during the period 27 February 2020 to 29 April 2020. NSAID users (defined as individuals having filled a prescription for NSAIDs up to 30 days before the SARS-CoV-2 test) were matched to up to 4 non-users on calendar week of the test date and propensity scores based on age, sex, relevant comorbidities, and use of selected prescription drugs. The main outcome was 30-day mortality, and NSAID users were compared to non-users using risk ratios (RRs) and risk differences (RDs). Secondary outcomes included hospitalization, intensive care unit (ICU) admission, mechanical ventilation, and acute renal replacement therapy. A total of 9,236 SARS-CoV-2 PCR-positive individuals were eligible for inclusion. The median age in the study cohort was 50 years, and 58% were female. Of these, 248 (2.7%) had filled a prescription for NSAIDs, and 535 (5.8%) died within 30 days. In the matched analyses, treatment with NSAIDs was not associated with 30-day mortality (RR 1.02, 95% CI 0.57 to 1.82, p = 0.95; RD 0.1%, 95% CI -3.5% to 3.7%, p = 0.95), risk of hospitalization (RR 1.16, 95% CI 0.87 to 1.53, p = 0.31; RD 3.3%, 95% CI -3.4% to 10%, p = 0.33), ICU admission (RR 1.04, 95% CI 0.54 to 2.02, p = 0.90; RD 0.2%, 95% CI -3.0% to 3.4%, p = 0.90), mechanical ventilation (RR 1.14, 95% CI 0.56 to 2.30, p = 0.72; RD 0.5%, 95% CI -2.5% to 3.6%, p = 0.73), or renal replacement therapy (RR 0.86, 95% CI 0.24 to 3.09, p = 0.81; RD -0.2%, 95% CI -2.0% to 1.6%, p = 0.81). The main limitations of the study are possible exposure misclassification, as not all individuals who fill an NSAID prescription use the drug continuously, and possible residual confounding by indication, as NSAIDs may generally be prescribed to healthier individuals due to their side effects, but on the other hand may also be prescribed for early symptoms of severe COVID-19. CONCLUSIONS Use of NSAIDs was not associated with 30-day mortality, hospitalization, ICU admission, mechanical ventilation, or renal replacement therapy in Danish individuals who tested positive for SARS-CoV-2. TRIAL REGISTRATION The European Union electronic Register of Post-Authorisation Studies EUPAS34734.
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Affiliation(s)
- Lars Christian Lund
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kasper Bruun Kristensen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mette Reilev
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Steffen Christensen
- Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Henrik Støvring
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Nanna Borup Johansen
- Department of Medical Evaluation and Biostatistics, Danish Medicines Agency, Copenhagen, Denmark
| | - Nikolai Constantin Brun
- Department of Medical Evaluation and Biostatistics, Danish Medicines Agency, Copenhagen, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
- * E-mail:
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de la Cour CD, Verdoodt F, Aalborg GL, von Buchwald C, Friis S, Dehlendorff C, Kjaer SK. Low-dose aspirin use and risk of head and neck cancer-A Danish nationwide case-control study. Br J Clin Pharmacol 2020; 87:1561-1567. [PMID: 32737902 DOI: 10.1111/bcp.14502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 05/25/2020] [Accepted: 07/13/2020] [Indexed: 11/26/2022] Open
Abstract
Results concerning a potential preventive effect of aspirin on head and neck cancer (HNC) are conflicting. We examined the association between low-dose aspirin use and HNC risk overall and by degree of human papillomavirus association in a nested case-control study using nationwide registries. Cases (n = 12 389) were all Danish residents diagnosed with primary HNC (2000-2015). Age- and sex-matched population controls (n = 185 835) were selected by risk-set-sampling. Using conditional logistic regression, we estimated multivariable-adjusted odds ratios and 95% confidence intervals for HNC associated with low-dose aspirin use (≥2 prescriptions). No association was observed between low-dose aspirin ever-use and overall HNC (odds ratio: 1.03, 95% confidence interval: 0.97-1.10). Estimates remained neutral according to patterns of use. Low-dose aspirin use appeared to slightly decrease HNC risk among the eldest (71-84 y), independently of human papillomavirus association, while slightly increase HNC risk among younger age groups (30-60, 61-70 y), driven by an increased risk of oral cancer. However, no consistent patterns in risk estimates were found according to duration and consistency of low-dose aspirin use in the age-stratified analyses.
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Affiliation(s)
- Cecilie D de la Cour
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Freija Verdoodt
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Gitte L Aalborg
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren Friis
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christian Dehlendorff
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Lund LC, Reilev M, Hallas J, Kristensen KB, Thomsen RW, Christiansen CF, Sørensen HT, Johansen NB, Brun NC, Voldstedlund M, Støvring H, Thomsen MK, Christensen S, Pottegård A. Association of Nonsteroidal Anti-inflammatory Drug Use and Adverse Outcomes Among Patients Hospitalized With Influenza. JAMA Netw Open 2020; 3:e2013880. [PMID: 32609352 PMCID: PMC7330719 DOI: 10.1001/jamanetworkopen.2020.13880] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE During the ongoing coronavirus disease 2019 pandemic, case reports have suggested that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may lead to adverse outcomes. OBJECTIVE To study the association of NSAID use with adverse outcomes in patients hospitalized with influenza or influenza pneumonia. DESIGN, SETTING, AND PARTICIPANTS This cohort study used propensity score matching among 7747 individuals aged 40 years or older who were hospitalized with influenza, confirmed by polymerase chain reaction or antigen testing, between 2010 and 2018. Data were collected using Danish nationwide registers. All analyses reported were performed on May 29, 2020. EXPOSURES Prescription fill of an NSAID within 60 days before admission. MAIN OUTCOMES AND MEASURES Risk ratio (RR) and risk difference (RD) with 95% CIs for intensive care unit admission and death within 30 days of admission. RESULTS A total of 7747 patients (median [interquartile range] age, 71 [59-80] years, 3980 [51.4%] men) with confirmed influenza were identified. Of these, 520 (6.7%) were exposed to NSAIDs. In the unmatched cohorts, 104 of 520 patients (20.0%) who used NSAIDs and 958 of 7227 patients (13.3%) who did not use NSAIDs were admitted to the intensive care unit. For death within 30 days of admission, we observed 37 events (7.1%) among those who used NSAIDs compared with 563 events (7.8%) among those who did not. Current NSAID use was associated with intensive care unit admission (RR, 1.51; 95% CI, 1.26 to 1.81; RD, 6.7%; 95% CI, 3.2% to 10.3%), while NSAID use was not associated with death (RR, 0.91; 95% CI, 0.66 to 1.26; RD, -0.7%; 95% CI, -3.0% to 1.6%). In the matched cohorts, risks were unchanged for patients who used NSAIDs, while 83 ICU admissions (16.0%) and 36 deaths (6.9%) were observed among matched individuals who did not use NSAIDs. Matched (ie, adjusted) analyses yielded attenuated risk estimates for intensive care unit admission (RR, 1.25; 95% CI, 0.95 to 1.63; RD, 4.0%; 95% CI, -0.6% to 8.7%) and death (RR, 1.03; 95% CI, 0.66 to 1.60; RD, 0.2%; 95% CI, -2.9% to 3.3%). Associations were more pronounced among patients who used NSAIDs for a longer period (eg, for intensive care unit admission: RR, 1.90; 95% CI, 1.19 to 3.06; RD, 13.4%; 95% CI, 4.0% to 22.8%). CONCLUSIONS AND RELEVANCE In this cohort study of adult patients hospitalized with influenza, the use of NSAIDs was not associated with 30-day intensive care unit admission or death in adjusted analyses. There was an association between long-term use of NSAIDs and intensive care unit admission.
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Affiliation(s)
- Lars Christian Lund
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mette Reilev
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry and Clinical Pharmacology, Odense University Hospital, Odense, Denmark
| | - Kasper Bruun Kristensen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Center for Population Health and Sciences, Stanford University, Stanford, California
| | - Nanna Borup Johansen
- Department of Medical Evaluation and Biostatistics, Danish Medicines Agency, Copenhagen, Denmark
| | - Nikolai Constantin Brun
- Department of Medical Evaluation and Biostatistics, Danish Medicines Agency, Copenhagen, Denmark
| | | | - Henrik Støvring
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Public Health–Biostatistics, Aarhus University, Aarhus, Denmark
| | | | - Steffen Christensen
- Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark
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Schmidt M, Pottegård A. Prescriber responsibility, predictors for initiation, and 20-year trends in use of non-aspirin non-steroidal anti-inflammatory drugs in patients with cardiovascular contraindications: a nationwide cohort study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:496-506. [PMID: 32584988 DOI: 10.1093/ehjcvp/pvaa073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/16/2020] [Indexed: 11/13/2022]
Abstract
AIMS To examine whether prescription patterns complied with recommendations not to use nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with cardiovascular contraindications. Moreover, we examined predictors for initiation and prescriber responsibility. METHODS AND RESULTS We identified first-time cardiovascular diseases from medical databases (1996-2017). We assessed standardized prevalence proportions, predictors from logistic regression, and prescriber identifiers. 1-year prevalence of NSAID initiation increased 3.4% from 1996 (19.4%) to 2001 (22.7%) and declined by 2.7% thereafter until 2017 (13.5%). Trends were independent of age, sex, and disease subtype, although larger annual declines occurred for heart failure (3.9%) and ischemic heart disease (3.5%) since 2002. One-year prevalence remained highest among patients with venous thromboembolism (16.6%) and angina (13.8%), and lowest for ST-segment elevation myocardial infarction (7.0%) and heart failure (8.8%). Initiators were predominantly prescribed ibuprofen (59%), diclofenac (23%) and etodolac (6%). Diclofenac and coxib use declined, while ibuprofen and naproxen use increased. Median prescribed pill dose of ibuprofen declined after 2008 from moderate/high (600 mg) to low (400 mg). Treatment duration declined for all NSAIDs, except celecoxib. Rheumatic, obesity, and pain-related conditions predicted NSAID initiation. General practitioners issued 86-91% of all NSAID prescriptions, followed by hospital prescribers (7.3-12%). CONCLUSIONS Initiation of NSAIDs in patients with cardiovascular disease declined since 2002. Shorter treatment duration, declining COX-2 inhibition, and increasing use of naproxen and low-dose ibuprofen suggest adherence to guidelines when NSAIDs cannot be avoided. Still, NSAID use remained prevalent despite cardiovascular contraindications, warranting awareness of appropriateness of use among general practitioners in particular.
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Affiliation(s)
- Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
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Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective, widely used analgesics. For the past 2 decades, considerable attention has been focused on their cardiovascular safety. After early studies indicating an association between NSAID use and increased risks of heart failure and elevated blood pressure, subsequent studies found a link between NSAID use and an increased risk of thrombotic events. Selective cyclooxygenase 2 (COX2) inhibitors (also known as coxibs) have been associated with the greatest risk of adverse vascular effects but concern also relates to non-selective NSAIDs, especially those with strong COX2 inhibition such as diclofenac. Although NSAID use is discouraged in patients with cardiovascular disease, pain-relief medication is often required and, in the absence of analgesics that are at least as effective but safer, NSAIDs are frequently prescribed. Furthermore, non-prescription use of NSAIDs, even among people with underlying cardiovascular risks, is largely unsupervised and varies widely between countries. As concern mounts about the disadvantages of alternatives to NSAIDs (such as opioids) for pain management, the use of NSAIDs is likely to rise. Given that the pharmaceutical development pipeline lacks new analgesics, health-care professionals, patients and medicine regulatory authorities are focused on optimizing the safe use of NSAIDs. In this Review, we summarize the current evidence on the cardiovascular safety of NSAIDs and present an approach for their use in the context of holistic pain management.
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Gaist D, García Rodríguez LA, Hald SM, Hellfritzsch M, Poulsen FR, Halle B, Hallas J, Pottegård A. Antidepressant drug use and subdural hematoma risk. J Thromb Haemost 2020; 18:318-327. [PMID: 31609047 DOI: 10.1111/jth.14658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/11/2019] [Accepted: 10/02/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) use may be associated with development of subdural hematoma (SDH). OBJECTIVES To estimate SDH risk associated with antidepressant use, including when combined with antithrombotics, or nonsteroidal anti-inflammatory drugs (NSAIDs). PATIENTS/METHODS We performed this case-control study based on Danish registries. We included 10 885 incident cases of SDH and 435 379 matched general population controls. We calculated odds ratios (95% confidence interval) adjusted for comorbidity, co-medication, education level, and income (aOR). RESULTS We found that current use of SSRIs (aOR1.32 [1.25-1.38]) and non-SSRIs (aOR 1.19 [1.13-1.26]) was associated with a higher SDH risk, compared with non-use of antidepressants. Risks were higher with short duration of current use (eg, <1 month of current use: aOR 2.55 [2.07-3.15] for SSRI, 1.88 [1.46-2.41] for non-SSRIs; >3 years of current use: 1.04 [0.93-1.17] for SSRI and 1.12 [0.98-1.28] for non-SSRIs). Combined use of antidepressants with either antithrombotics or NSAIDs yielded similar ORs to those observed for single use of antithrombotics or NSAIDs. Stronger associations were observed for antidepressants combined with both vitamin K antagonists (VKAs) and NSAIDs (SSRI, VKA, & NSAID: aOR 5.51 [2.70-11-22]; non-SSRI, VKA, & NSAID: 6.81 [2.37-19-60]). CONCLUSIONS Antidepressant use was associated with higher risk of SDH that seemed largely restricted to first year of treatment. In absolute terms this risk is judged to be small, given the low SDH incidence rate. With one possible exception (triple use of antidepressants, NSAIDs, and VKAs), risk estimates of SDH for combined regimens of antidepressants with antithrombotics or NSAIDs provided little evidence of interactions.
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Affiliation(s)
- David Gaist
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Stine Munk Hald
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Maja Hellfritzsch
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Frantz R Poulsen
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
| | - Bo Halle
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Sperling CD, Verdoodt F, Aalborg GL, Dehlendorff C, Friis S, Kjaer SK. Low-dose aspirin use and endometrial cancer mortality—a Danish nationwide cohort study. Int J Epidemiol 2019; 49:330-337. [DOI: 10.1093/ije/dyz253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Background
Accumulating evidence suggests that aspirin use may improve survival in cancer patients, however, for endometrial cancer, epidemiological evidence is limited and results are equivocal. In a nationwide cohort study, we examined the association between post-diagnostic low-dose aspirin use and endometrial cancer mortality.
Methods
From the Danish Cancer Registry, we identified all women with a primary diagnosis of endometrial cancer. Women diagnosed between 2000 and 2012, aged 30–84 years, who had no history of cancer (except non-melanoma skin cancer) and were alive 1 year after the cancer diagnosis were eligible. We obtained information on pre- and post-diagnostic use (≥1 prescription) of low-dose aspirin, mortality and potential confounding factors from nationwide registries. Using Cox regression models, we estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between post-diagnostic low-dose aspirin use and endometrial cancer mortality. The exposure was modelled as both time-varying as well as time-fixed within exposure windows of 1 and 5 years.
Results
We identified 6694 endometrial cancer patients with a maximum follow-up of 13 years. In the time-varying analysis, post-diagnostic low-dose aspirin use was associated with a HR of 1.10 (95% CI 0.90–1.33) for endometrial cancer mortality. We found no indication of a dose–response association according to increasing tablet strength, cumulative amount or duration of use, and the HRs were similar for pre-diagnostic and post-diagnostic low-dose aspirin use compared with non-use.
Conclusions
We found no indication that post-diagnostic low-dose aspirin use was associated with reduced mortality for endometrial cancer; rather our findings suggested a concern for increased mortality.
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Affiliation(s)
- Cecilie D Sperling
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Freija Verdoodt
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Gitte L Aalborg
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christian Dehlendorff
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Søren Friis
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Skriver C, Dehlendorff C, Borre M, Brasso K, Larsen SB, Tjønneland A, Pottegård A, Hallas J, Sørensen HT, Friis S. Associations of low-dose aspirin or other NSAID use with prostate cancer risk in the Danish Diet, Cancer and Health Study. Cancer Causes Control 2019; 31:139-151. [DOI: 10.1007/s10552-019-01252-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/20/2019] [Indexed: 01/21/2023]
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Smit J, Dalager-Pedersen M, Adelborg K, Kaasch AJ, Thomsen RW, Frøslev T, Nielsen H, Schønheyder HC, Sørensen HT, Desimone CV, Desimone DC, Søgaard M. Influence of Acetylsalicylic Acid Use on Risk and Outcome of Community-Acquired Staphylococcus aureus Bacteremia: A Population-Based Study. Open Forum Infect Dis 2019; 6:ofz356. [PMID: 31660413 PMCID: PMC6754079 DOI: 10.1093/ofid/ofz356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/01/2019] [Indexed: 12/03/2022] Open
Abstract
Objective To investigate the influence of acetylsalicylic acid (ASA) use on risk and outcome of community-acquired Staphylococcus aureus bacteremia (CA-SAB). Method We used population-based medical databases to identify all patients diagnosed in northern Denmark with first-time CA-SAB and matched population controls from 2000–2011. Categories for ASA users included current users (new or long-term users), former users, and nonusers. The analyses were adjusted for comorbidities, comedication use, and socioeconomic indicators. Results We identified 2638 patients with first-time CA-SAB and 26 379 matched population controls. Compared with nonusers, the adjusted odds ratio (aOR) for CA-SAB was 1.00 (95% confidence interval [CI], 0.88–1.13) for current users, 1.00 (95% CI, 0.86–1.16) for former users, 2.04 (95% CI, 1.42–2.94) for new users, and 0.95 (95% CI, 0.84–1.09) for long-term users. Thirty-day cumulative mortality was 28.0% among current users compared with 21.6% among nonusers, yielding an adjusted hazard rate ratio (aHRR) of 1.02 (95% CI, 0.84–1.25). Compared with nonusers, the aHRR was 1.10 (95% CI, 0.87–1.40) for former users, 0.60 (95% CI, 0.29–1.21) for new users, and 1.06 (95% CI, 0.87–1.31) for long-term users. We observed no difference in the risk or outcome of CA-SAB with increasing ASA dose or by presence of diseases commonly treated with ASA. Conclusions Use of ASA did not seem to influence the risk or outcome of CA-SAB. The apparent increased risk among new users may relate to residual confounding from the circumstances underlying ASA treatment initiation. Our finding of no association remained robust with increasing ASA dose and across multiple patient subsets.
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Affiliation(s)
- Jesper Smit
- Department of Infectious Diseases, Aalborg University Hospital, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | | | - Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.,Department of Clinical Biochemistry, Aarhus University Hospital, Denmark
| | - Achim J Kaasch
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University, Düsseldorf, Germany
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Denmark.,Department of Clinical Medicine, Aalborg University, Denmark
| | - Henrik C Schønheyder
- Department of Clinical Medicine, Aalborg University, Denmark.,Department of Clinical Microbiology, Aalborg University Hospital, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | | | - Daniel C Desimone
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Minnesota.,Division of Infectious Diseases, Mayo Clinic Rochester, Minnesota
| | - Mette Søgaard
- Aalborg Thrombosis Research Unit, Aalborg University, Denmark.,Department of Cardiology, Aalborg University Hospital, Denmark
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Nissen SK, Pottegård A, Ryg J. Trends of Opioid Utilisation in Denmark: A Nationwide Study. Drugs Real World Outcomes 2019; 6:155-164. [PMID: 31535353 PMCID: PMC6879688 DOI: 10.1007/s40801-019-00163-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Opioid use has more than doubled over recent decades, and Denmark occupies fifth place in the global ranking. These increases have been partly attributed to the ageing population. Objective Our objective was to assess the impact of age over time on utilisation of the most commonly used opioids in Denmark. Methods We retrieved nationwide sales data on opioid sales in Denmark from 1999 to 2017. We investigated utilisation trends in age groups for the four opioids with the highest use. We used three volume-based metrics (defined daily doses/1000/day, oral morphine equivalents/1000/day, and packages dispensed/year) and one person-based metric (users/1000/year). Results The four opioids selected according to users/1000/year were tramadol (46.1), codeine and combination products (12.4 for codeine, 3.7 for codeine and acetylsalicylic acid, and 4.2 for codeine and paracetamol), morphine (17.0), and oxycodone (12.1). Overall utilisation according to volume and person metrics increased for all except codeine and combination products. Tramadol doses or strength increased, albeit less with increasing age. Oxycodone doses or strength decreased for all age groups but were nearly unchanged for the age group ≥ 80 years. Conclusion Tramadol is the most utilised opioid in Denmark and was prescribed at increasing doses or strengths over the study period, particularly in the younger (< 80 years) age groups. Overall, oxycodone was prescribed at decreasing doses or strengths over time but remained unchanged for the age group ≥ 80 years. There is a need to address the pharmacological treatment of pain in terms of age, with tramadol and oxycodone being possible targets for regulatory efforts. Electronic supplementary material The online version of this article (10.1007/s40801-019-00163-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Søren Kabell Nissen
- Department of Geriatric Medicine, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense C, Denmark.
| | - Anton Pottegård
- Department of Public Health, University of Southern Denmark, Clinical Pharmacology and Pharmacy, J. B. Winsløwsvej 19, 3, 5000, Odense C, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, J. B. Winsløwsvej 19, 3, 5000, Odense C, Denmark
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Lee CJY, Gerds TA, Carlson N, Bonde AN, Gislason GH, Lamberts M, Olesen JB, Pallisgaard JL, Hansen ML, Torp-Pedersen C. Risk of Myocardial Infarction in Anticoagulated Patients With Atrial Fibrillation. J Am Coll Cardiol 2019; 72:17-26. [PMID: 29957227 DOI: 10.1016/j.jacc.2018.04.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/11/2018] [Accepted: 04/03/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Evidence is conflicting as to the efficacy of direct oral anticoagulation (DOAC) and vitamin K antagonist (VKA) for prevention of myocardial infarction (MI). OBJECTIVES This study aimed to investigate the risk of MI associated with the use of apixaban, dabigatran, rivaroxaban, and VKA in patients with atrial fibrillation. METHODS Patients with atrial fibrillation were identified using Danish health care registers and stratified by initial oral anticoagulant treatment. Standardized absolute 1-year risks were estimated based on Cox regression for hazard rates of MI hospitalizations and mortality. Reported were absolute risks separately for the oral anticoagulation treatments and standardized to the characteristics of the study population. RESULTS Of the 31,739 patients included (median age, 74 years; 47% females), the standardized 1-year risk of MI for VKA was 1.6% (95% confidence interval [CI]: 1.3 to 1.8), apixaban was 1.2% (95% CI: 0.9 to 1.4), dabigatran was 1.2% (95% CI: 1.0 to 1.5), and rivaroxaban was 1.1% (95% CI: 0.8 to 1.3). No significant risk differences were observed in the standardized 1-year risks of MI among the DOACs: dabigatran versus apixaban (0.04%; 95% CI: -0.3 to 0.4), rivaroxaban versus apixaban (0.1%; 95% CI: -0.4 to 0.3), and rivaroxaban versus dabigatran (-0.1%; 95% CI: -0.5 to 0.2). The risk differences for DOACs versus VKA were all significant: -0.4% (95% CI: -0.7 to -0.1) for apixaban, -0.4% (95% CI: -0.7 to -0.03) for dabigatran, and -0.5% (95% CI: -0.8 to -0.2) for rivaroxaban. CONCLUSIONS No significant risk differences of MI were found in the direct comparisons of DOACs, and DOACs were all associated with a significant risk reduction of MI compared with VKA.
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Affiliation(s)
- Christina Ji-Young Lee
- Department of Health Science and Technology, Aalborg University and Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark.
| | - Thomas Alexander Gerds
- Department of Biostatistics, Copenhagen University, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - Nicholas Carlson
- Department of Internal Medicine, Holbaek Hospital, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - Anders Nissen Bonde
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Gunnar Hilmar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - Morten Lamberts
- The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jonas Bjerring Olesen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | | | - Morten Lock Hansen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Health Science and Technology, Aalborg University and Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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Use of nonaspirin nonsteroidal anti‐inflammatory drugs and risk of head and neck cancer: A nationwide case–control study. Int J Cancer 2019; 146:2139-2146. [DOI: 10.1002/ijc.32544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 01/21/2023]
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Schmidt M, Schmidt SAJ, Adelborg K, Sundbøll J, Laugesen K, Ehrenstein V, Sørensen HT. The Danish health care system and epidemiological research: from health care contacts to database records. Clin Epidemiol 2019; 11:563-591. [PMID: 31372058 PMCID: PMC6634267 DOI: 10.2147/clep.s179083] [Citation(s) in RCA: 720] [Impact Index Per Article: 144.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 02/20/2019] [Indexed: 01/04/2023] Open
Abstract
Denmark has a large network of population-based medical databases, which routinely collect high-quality data as a by-product of health care provision. The Danish medical databases include administrative, health, and clinical quality databases. Understanding the full research potential of these data sources requires insight into the underlying health care system. This review describes key elements of the Danish health care system from planning and delivery to record generation. First, it presents the history of the health care system, its overall organization and financing. Second, it details delivery of primary, hospital, psychiatric, and elderly care. Third, the path from a health care contact to a database record is followed. Finally, an overview of the available data sources is presented. This review discusses the data quality of each type of medical database and describes the relative technical ease and cost-effectiveness of exact individual-level linkage among them. It is shown, from an epidemiological point of view, how Denmark’s population represents an open dynamic cohort with complete long-term follow-up, censored only at emigration or death. It is concluded that Denmark’s constellation of universal health care, long-standing routine registration of most health and life events, and the possibility of exact individual-level data linkage provides unlimited possibilities for epidemiological research.
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Affiliation(s)
- Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
| | - Sigrun Alba Johannesdottir Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Sundbøll
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kristina Laugesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Langan SM, Schmidt SAJ, Wing K, Ehrenstein V, Nicholls SG, Filion KB, Klungel O, Petersen I, Sørensen HT, Dixon WG, Guttmann A, Harron K, Hemkens LG, Moher D, Schneeweiss S, Smeeth L, Sturkenboom M, von Elm E, Wang SV, Benchimol EI. La déclaration RECORD-PE (Reporting of Studies Conducted Using Observational Routinely Collected Health Data Statement for Pharmacoepdemiology) : directives pour la communication des études realisées à partir de données de santé observationelles collectées en routine en pharmacoépidémiologie. CMAJ 2019; 191:E689-E708. [PMID: 31235490 PMCID: PMC6592814 DOI: 10.1503/cmaj.190347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Sinéad M Langan
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont.
| | - Sigrún A J Schmidt
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Kevin Wing
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Vera Ehrenstein
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Stuart G Nicholls
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Kristian B Filion
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Olaf Klungel
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Irene Petersen
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Henrik T Sørensen
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - William G Dixon
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Astrid Guttmann
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Katie Harron
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Lars G Hemkens
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - David Moher
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Sebastian Schneeweiss
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Miriam Sturkenboom
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Erik von Elm
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Shirley V Wang
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
| | - Eric I Benchimol
- Faculty of Epidemiology and Population Health (Langan, Wing, Smeeth), London School of Hygiene and Tropical Medicine, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Schmidt, Ehrenstein, Petersen, Sørensen), université d'Aarhus, Aarhus, Danemark ; Institut de recherche de l'Hôpital d'Ottawa (Nicholls, Moher) ; École d'épidémiologie et de santé publique (Nicholls), Université d'Ottawa, Ottawa, Ont. ; Département d'épidémiologie, de bio-statistique et de santé au travail (Filion), Université McGill ; Centre d'épidémiologie clinique (Filion), Institut Lady Davis, Hôpital général juif, Montréal, Qué. ; Division of Pharmacoepidemiology and Clinical Pharmacology (Klungel), Utrecht Institute for Pharmaceutical Sciences, université d'Utrecht, Utrecht, Pays-Bas ; Department of Primary Care and Population Health (Petersen), University College London, Londres, Royaume-Uni ; Arthritis Research UK Centre for Epidemiology (Dixon), Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, Royaume-Uni ; ICES (Guttmann, Benchimol) ; Department of Paediatrics (Guttmann), The Hospital for Sick Children, université de Toronto, Toronto, Ont. ; Population, Policy and Practice Programme (Harron), Great Ormond Street Institute of Child Health, University College London, Londres, Royaume-Uni ; Basel Institute for Clinical Epidemiology and Biostatistics (Hemkens), Department of Clinical Research, University Hospital of Basel, université de Basel, Basel, Suisse ; Division of Pharmacoepidemiology and Pharmacoeconomics (Schneeweiss, Wang), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. ; Julius Global Health (Sturkenboom), University Medical Center Utrecht, Utrecht, Pays-Bas ; Cochrane Suisse (von Elm), Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse ; Département de pédiatrie et École d'épidémiologie et de santé publique (Benchimol), Université d'Ottawa ; Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol), Ottawa, Ont
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48
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Würtz M, Olesen KKW, Thim T, Kristensen SD, Eikelboom JW, Maeng M. External applicability of the COMPASS trial: the Western Denmark Heart Registry. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2019; 5:192-199. [PMID: 30916315 DOI: 10.1093/ehjcvp/pvz013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/21/2019] [Accepted: 03/25/2019] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
In the COMPASS trial, combined aspirin and rivaroxaban treatment reduced ischaemic events in patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD). We estimated the proportion of COMPASS eligible patients among unselected patients undergoing coronary angiography (CAG) and compared outcome rates among COMPASS eligible and non-eligible patients.
Methods and results
We applied the COMPASS study criteria on patients undergoing CAG in Western Denmark (2004–11). Both COMPASS eligible and non-eligible patients had CAD/PAD and met no exclusion criteria, but only COMPASS eligible patients met the inclusion criteria. We assessed the COMPASS primary endpoint of cardiovascular death, ischaemic stroke, haemorrhagic stroke, or myocardial infarction (MI). We computed event rates and adjusted incidence rate ratios (aIRRs). Of 80 071 patients undergoing CAG, 27 939 did not have CAD or PAD and were not considered. Of the 52 132 patients remaining, 11 930 were COMPASS eligible. Rates of the primary endpoint were 4.8 (95% confidence interval 4.6–5.0) events per 100 person-years among COMPASS eligible patients and 2.3 (2.2–2.4) among COMPASS non-eligible patients [aIRR 1.7 (1.6–1.9)]. COMPASS eligible patients also had higher risks of cardiovascular death [aIRR 2.5 (2.1–3.0)], ischaemic stroke [aIRR 1.4 (1.2–1.6)], and MI [aIRR 1.9 (1.7–2.1)].
Conclusion
In this all-comers CAG cohort, 15% were eligible for combined aspirin and rivaroxaban treatment. COMPASS eligible patients had up to 2.5-fold higher rates of cardiovascular events than non-eligible patients. The higher incidence of ischaemic events in COMPASS eligible patients highlights an unmet need for additional preventive measures.
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Affiliation(s)
- Morten Würtz
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK Aarhus, Denmark
- Department of Cardiology, Regional Hospital West Jutland, Gl. Landevej 61, DK Herning, Denmark
| | - Kevin Kris Warnakula Olesen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK Aarhus, Denmark
| | - Troels Thim
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK Aarhus, Denmark
| | - Steen Dalby Kristensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK Aarhus, Denmark
| | - John W Eikelboom
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton Street East, Ontario, Canada
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK Aarhus, Denmark
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49
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Glassou EN, Kristensen N, Møller BK, Erikstrup C, Hansen TB, Pedersen AB. Impact of preadmission anti-inflammatory drug use on the risk of RBC transfusion in elderly hip fracture patients: a Danish nationwide cohort study, 2005-2016. Transfusion 2019; 59:935-944. [PMID: 30610758 DOI: 10.1111/trf.15110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 11/02/2018] [Accepted: 11/12/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Do prescription drugs with anti-inflammatory properties such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and statins increase the risk of postoperative bleeding measured with RBC transfusion in elderly hip fracture surgery patients? STUDY DESIGN AND METHODS Using the Danish Multidisciplinary Hip Fracture Database, 74,791 patients aged 65 years or older with surgery-treated hip fracture were identified during 2005-2016, and their use of NSAIDs, corticosteroids, and statins was ascertained. For each drug, patients were categorized as nonusers (no prescription ≤365 days prior to surgery), former users (one prescription 91-365 days), and current users (one prescription ≤90 days). Information on surgical treatment, transfusion, other medication and comorbidities were collected using Danish nationwide registries. A log-binomial model was used to estimate relative risks for RBC transfusion within 7 days of surgery and corresponding 95% confidence intervals. Adjustments were made for patient- and surgery-related factors. RESULTS Former and current users of NSAIDs, corticosteroids, and statins accounted for 22%, 10%, and 24%, respectively. Current users of NSAIDs had an increased adjusted relative risk of transfusion (1.07; confidence interval, 1.04-1.10) compared to nonusers. There was no association between current users of corticosteroids and statins and risk of transfusion. CONCLUSION NSAID use within 90 days of a hip fracture surgery was associated with an increased risk of RBC transfusion. Thus, current use of NSAIDs can be associated with an increased risk of postoperative bleeding, but we cannot rule out the influence of confounding.
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Affiliation(s)
- Eva N Glassou
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Aarhus University, Holstebro, Denmark
| | - Nickolaj Kristensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarne K Møller
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Torben B Hansen
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Aarhus University, Holstebro, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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50
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Pottegård A, Schmidt SAJ, Wallach-Kildemoes H, Sørensen HT, Hallas J, Schmidt M. Data Resource Profile: The Danish National Prescription Registry. Int J Epidemiol 2018; 46:798-798f. [PMID: 27789670 PMCID: PMC5837522 DOI: 10.1093/ije/dyw213] [Citation(s) in RCA: 431] [Impact Index Per Article: 71.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Anton Pottegård
- Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | | | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Internal Medicine, Regional Hospital of Randers, Randers, Denmark
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