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Høyer S, Riis AH, Toft G, Wise LA, Hatch EE, Wesselink AK, Rothman KJ, Sørensen HT, Mikkelsen EM. Male alcohol consumption and fecundability. Hum Reprod 2021; 35:816-825. [PMID: 32155263 DOI: 10.1093/humrep/dez294] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 11/03/2019] [Indexed: 01/01/2023] Open
Abstract
STUDY QUESTION Does male alcohol consumption affect fecundability? SUMMARY ANSWER In data pooled across Danish and North American preconception cohort studies, we found little evidence of an association between male alcohol consumption and reduced fecundability. WHAT IS KNOWN ALREADY Experimental and clinical studies have shown that alcohol affects male reproductive physiology, mainly by altering male reproductive hormones and spermatogenesis. However, few epidemiologic studies have examined the association between alcohol consumption and male fertility. STUDY DESIGN, SIZE, DURATION Data were collected from two ongoing prospective preconception cohort studies: the Danish 'SnartForaeldre' (SF) study (662 couples) and the North American 'Pregnancy Study Online' (PRESTO) (2017 couples). Participants included in the current analysis were enrolled from August 2011 through June 2019 (SF) and from June 2013 through June 2019 (PRESTO). PARTICIPANTS/MATERIALS, SETTING, METHODS Eligible men were aged ≥18 years in SF and ≥21 years in PRESTO, in a stable relationship with a female partner and not using contraception or receiving fertility treatment. In both cohorts, alcohol consumption/serving size was self-reported as number of beers (330 mL/12 oz.), glasses of white or red wine (120 mL/4 oz. each), dessert wine (50 mL/2 oz.) and spirits (20 mL/1.5 oz.). Overall alcohol consumption was categorized as none, 1-5, 6-13 and ≥14 standard servings per week. Total menstrual cycles at risk were calculated using data from female partners' follow-up questionnaires, which were completed every 8 weeks until self-reported pregnancy or 12 menstrual cycles, whichever came first. Analyses were restricted to couples that had been trying to conceive for ≤6 cycles at study entry. Proportional probability regression models were used to compute fecundability ratios (FRs) and 95% confidence interval (CIs). We adjusted for male and female age, female partner's alcohol consumption, intercourse frequency, previous history of fathering a child, race/ethnicity, education, BMI, smoking and consumption of sugar-sweetened beverages and caffeine. MAIN RESULTS AND THE ROLE OF CHANCE The cumulative proportion of couples who conceived during 12 cycles of follow-up were 1727 (64.5%). The median (interquartile range) of total male alcohol consumption was 4.5 (2.0-7.8) and 4.1 (1.0-8.6) standard servings per week in the SF and PRESTO cohorts, respectively. In pooled analyses, adjusted FRs for male alcohol consumption of 1-5, 6-13 and ≥14 standard servings per week compared with no alcohol consumption were 1.02 (95% CI: 0.90-1.17), 1.10 (95% CI: 0.96-1.27) and 0.98 (95% CI: 0.81-1.18), respectively. For SF, adjusted FRs of 1-5, 6-13 and ≥14 standard servings per week compared with no alcohol consumption were 0.97 (95% CI: 0.73-1.28), 0.81 (95% CI: 0.60-1.10) and 0.82 (95% CI: 0.51-1.30), respectively. For PRESTO, adjusted FRs of 1-5, 6-13 and ≥14 standard servings per week compared with no alcohol consumption were 1.02 (95% CI: 0.88-1.18), 1.20 (95% CI: 1.03-1.40) and 1.03 (95% CI: 0.84-1.26), respectively. LIMITATIONS, REASONS FOR CAUTION Male alcohol consumption was ascertained at baseline only, and we did not distinguish between regular and binge drinking. In addition, we had insufficient numbers to study the effects of specific types of alcoholic beverages. As always, residual confounding by unmeasured factors, such as dietary factors and mental health, cannot be ruled out. Comorbidities thought to play a role in the reproductive setting (i.e. cancer, metabolic syndrome) were not considered in this study; however, the prevalence of cancer and diabetes was low in this age group. Findings for the highest categories of alcohol consumption (6-13 and ≥14 servings/week) were not consistent across the two cohorts. WIDER IMPLICATIONS OF THE FINDINGS Despite little evidence of an association between male alcohol consumption and reduced fecundability in the pooled analysis, data from the Danish cohort might indicate a weak association between reduced fecundability and consumption of six or more servings per week. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the National Institutes of Health (R01-HD060680, R01-HD086742, R21-HD050264, R21-HD072326, R03-HD090315), the Novo Nordisk Foundation, Oticon Fonden, Politimester J.P.N. Colind og hustru Asmine Colinds mindelegat and Erna og Peter Houtveds studielegat. PRESTO receives in-kind donations from FertilityFriend.com, Kindara.com, Swiss Precision Diagnostics and Sandstone Diagnostics for the collection of data pertaining to fertility. Dr Wise serves as a consultant on uterine leiomyomata for AbbVie.com. All other authors declare no conflict of interest.
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Affiliation(s)
- S Høyer
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - A H Riis
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - G Toft
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - L A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 617857, USA
| | - E E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 617857, USA
| | - A K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 617857, USA
| | - K J Rothman
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark.,Department of Epidemiology, Boston University School of Public Health, Boston, MA 617857, USA.,RTI Health Solutions, Research Triangle Park, NC, 27709, USA
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark.,Department of Epidemiology, Boston University School of Public Health, Boston, MA 617857, USA
| | - E M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
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Grove EL, Steffensen FH, Riis AH, Nielsen LH, Jensen JM, Mathiasen ON, Ovrehus K, Botker HE, Sorensen HT, Norgaard BL. P3189Aspirin for prevention of cardiovascular events: an analysis of 27,451 patients from the Western Denmark Cardiac Computed Tomography Registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E L Grove
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - F H Steffensen
- Vejle Hospital, Department of Cardiology, Vejle, Denmark
| | - A H Riis
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - L H Nielsen
- Vejle Hospital, Department of Cardiology, Vejle, Denmark
| | - J M Jensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - O N Mathiasen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - K Ovrehus
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - H E Botker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H T Sorensen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - B L Norgaard
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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Cueto HT, Riis AH, Hatch EE, Wise LA, Rothman KJ, Sørensen HT, Mikkelsen EM. Folic acid supplementation and fecundability: a Danish prospective cohort study. Eur J Clin Nutr 2015; 70:66-71. [PMID: 26081493 DOI: 10.1038/ejcn.2015.94] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 04/10/2015] [Accepted: 05/14/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Periconceptional folic acid (FA) supplementation reduces the risk of neural tube defects and has been associated with ovulatory function. However, only two studies have associated supplementation with multivitamins (MVs) that contained FA with increased pregnancy rates. We aimed to examine the association between FA supplementation (obtained either through single FA tablets or through MVs) and fecundability. SUBJECTS/METHODS A prospective cohort study of 3895 Danish women who were planning a pregnancy between 2007 and 2011. We estimated fecundability ratios (FRs) and 95% confidence intervals (CIs) in relation to FA supplementation (either through single FA tablets or MV) using a proportional probabilities regression model, with adjustment for potential socio-demographic, reproductive and lifestyle confounders. In stratified analyses, we also estimated FR with 95% CI in relation to FA supplementation for women with regular and irregular cycles, respectively, and for women with short (<27 days), medium (27-29 days) and long cycles (⩾30 days), respectively. RESULTS FA supplementation was associated with increased fecundability (FR=1.15, 95% CI=1.06-1.25), compared with non-use. The adjusted FRs for FA supplement use relative to non-use were 1.35 (95% CI=1.12-1.65) and 1.11 (95% CI=1.01-1.22) for women with irregular and regular cycles, respectively, and 1.36 (95% CI=0.95-1.95), 1.10 (95% CI=0.98-1.22) and 1.24 (95% CI=1.10-1.41) for women with short (<27 days), medium (27-29 days) and long cycles (⩾30 days), respectively. CONCLUSIONS FA supplementation was associated with increased fecundability, and this association appeared to be stronger among women with irregular cycles and among women with either short or long cycle length.
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Affiliation(s)
- H T Cueto
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - A H Riis
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - E E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - L A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - K J Rothman
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,RTI International, Research Triangle Park, NC, USA
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - E M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Hahn KA, Wise LA, Rothman KJ, Mikkelsen EM, Brogly SB, Sørensen HT, Riis AH, Hatch EE. Caffeine and caffeinated beverage consumption and risk of spontaneous abortion. Hum Reprod 2015; 30:1246-55. [PMID: 25788567 DOI: 10.1093/humrep/dev063] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/26/2015] [Indexed: 12/24/2022] Open
Abstract
STUDY QUESTION Is caffeine and caffeinated beverage consumption associated with the risk of spontaneous abortion (SAB)? SUMMARY ANSWER While preconceptional caffeine consumption was not materially associated with an increased risk of SAB, consumption during early pregnancy was associated with a small increased risk of SAB, although the relation was not linear. WHAT IS KNOWN ALREADY Caffeine has been hypothesized as a risk factor for SAB since the 1980s; however, results from previous studies have been conflicting. STUDY DESIGN, SIZE, DURATION This prospective cohort study included 5132 Danish women planning pregnancy and enrolled from 2007 to 2010. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were women who conceived after entry into the Snart-Gravid cohort and who were aged 18-40, in a stable relationship with a male partner, and did not use fertility treatments to conceive. Women reported their daily caffeine and caffeinated beverage consumption on questionnaires before conception and during early pregnancy. All exposure measurements were prospective with respect to outcome ascertainment. We estimated hazard ratios (HRs) of SAB for categories of caffeine consumption in milligrams (mg) per day and the corresponding 95% confidence intervals (CIs) using Cox proportional hazards regression models with gestational weeks as the time scale. MAIN RESULTS AND THE ROLE OF CHANCE There were 732 women (14.3%) who were identified as having a SAB. In the preconceptional period, caffeine consumption was not materially associated with SAB risk (HR comparing ≥300 with <100 mg/day: 1.09; 95% CI: 0.89, 1.33). In early pregnancy, the HRs for 100-199, 200-299 and ≥300 mg/day of caffeine consumption were 1.62 (95% CI: 1.19, 2.22), 1.48 (95% CI: 1.03, 2.13) and 1.23 (95% CI: 0.61, 2.46), respectively, compared with that for <100 mg/day. LIMITATIONS, REASONS FOR CAUTION The observed results may be affected by non-differential exposure misclassification, reverse causation and residual confounding. WIDER IMPLICATIONS OF THE FINDINGS This is the largest study to date of prospectively measured, preconception caffeine consumption and risk of SAB. We were able to reduce the likelihood of differential left truncation bias and recall bias present in other analyses. STUDY FUNDING/COMPETING INTERESTS Snart-Gravid was funded by the NICHD (R21-050264). Dr. Hahn's work was funded in part by the BU Reproductive, Perinatal, and Pediatric Epidemiology Training Grant NIH #T32HD052458. There are no competing interests.
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Affiliation(s)
- K A Hahn
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - L A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA Slone Epidemiology Center, Boston University, Boston, MA 02215, USA
| | - K J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA RTI Health Solutions, Research Triangle Park, NC 12194 USA
| | - E M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - S B Brogly
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - H T Sørensen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - A H Riis
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - E E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
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Wildenschild C, Riis AH, Ehrenstein V, Hatch EE, Wise LA, Rothman KJ, Sørensen HT, Mikkelsen EM. A prospective cohort study of a woman's own gestational age and her fecundability. Hum Reprod 2015; 30:947-56. [PMID: 25678570 DOI: 10.1093/humrep/dev007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the magnitude of the association between a woman's gestational age at her own birth and her fecundability (cycle-specific probability of conception)? SUMMARY ANSWER We found a 62% decrease in fecundability among women born <34 weeks of gestation relative to women born at 37-41 weeks of gestation, whereas there were few differences in fecundability among women born at later gestational ages. WHAT IS KNOWN ALREADY One study, using retrospectively collected data on time-to-pregnancy (TTP), and self-reported data on gestational age, found a prolonged TTP among women born <37 gestational weeks (preterm) and with a birthweight ≤1500 g. Other studies of women's gestational age at birth and subsequent fertility, based on data from national birth registries, have reported a reduced probability of giving birth among women born <32 weeks of gestation. STUDY DESIGN, SIZE, DURATION We used data from a prospective cohort study of Danish pregnancy planners ('Snart-Gravid'), enrolled during 2007-2011 and followed until 2012. In all, 2814 women were enrolled in our study, of which 2569 had complete follow-up. PARTICIPANTS/MATERIALS, SETTING, METHODS Women eligible to participate were 18-40 years old at study entry, in a relationship with a male partner, and attempting to conceive. Participants completed a baseline questionnaire and up to six follow-up questionnaires until the report of pregnancy, discontinuation of pregnancy attempts, beginning of fertility treatment, loss to follow-up or end of study observation after 12 months. MAIN RESULTS AND THE ROLE OF CHANCE Among women born <34 gestational weeks, the cumulative probability of conception was 12, 28 and 48% within 3, 6 and 12 cycles, respectively. Among women born at 37-41 weeks of gestation, cumulative probability of conception was 47, 67 and 84% within 3, 6 and 12 cycles, respectively. Relative to women born at 37-41 weeks' gestation, women born <34 weeks had decreased fecundability (fecundability ratio (FR) 0.38, 95% confidence interval (CI): 0.17-0.82). Our data did not suggest reduced fecundability among women born at 34-36 weeks of gestation or at ≥42 weeks of gestation (FR 1.03, 95% CI: 0.80-1.34, and FR 1.13, 95% CI: 0.96-1.33, respectively). LIMITATIONS, REASONS FOR CAUTION Data on gestational age, obtained from the Danish Medical Birth Registry, were more likely to be based on date of last menstrual period than early ultrasound examination, possibly leading to an overestimation of gestational age at birth. Such overestimation, however, would not explain the decrease in fecundability observed among women born <34 gestational weeks. Another limitation is that the proportion of women born before 34 weeks of gestation was low in our study population, which reduced the precision of the estimates. WIDER IMPLICATIONS OF THE FINDINGS By using prospective data on TTP, our study elaborates on previous reports of impaired fertility among women born preterm, suggesting that women born <34 weeks of gestation have reduced fecundability. STUDY FUNDING/COMPETING INTERESTS The study was supported by the National Institute of Child Health and Human Development (R21-050264), the Danish Medical Research Council (271-07-0338), and the Health Research Fund of Central Denmark Region (1-01-72-84-10). The authors have no competing interests to declare.
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Affiliation(s)
- C Wildenschild
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - A H Riis
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - V Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - E E Hatch
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 617857, USA
| | - L A Wise
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 617857, USA Slone Epidemiology Center, Boston University, 1010 Commonwealth Ave, 4th Floor, Boston, MA 02215, USA
| | - K J Rothman
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 617857, USA RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC 27709, USA
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 617857, USA
| | - E M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
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Ostenfeld EB, Erichsen R, Thorlacius-Ussing O, Riis AH, Sørensen HT. Pre-admission use of glucocorticoids and 30-day mortality following colorectal cancer surgery: a population-based Danish cohort study. Aliment Pharmacol Ther 2014; 39:843-53. [PMID: 24611938 DOI: 10.1111/apt.12667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 01/20/2014] [Accepted: 01/29/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Previous studies indicate that pre-admission glucocorticoids increase the risk of perioperative complications. AIM To examine whether pre-admission use of glucocorticoids affects 30-day mortality after colorectal cancer (CRC) surgery. METHODS We conducted a nationwide population-based cohort study by linking Danish medical registries. All residents in Denmark who underwent CRC surgery from 2001 to 2011 were included. We characterised subjects who filled their most recent glucocorticoid prescription ≤90, 91-365 and >365 days before their surgery date as prevalent, recent and former users, respectively. Prevalent users were subgrouped into new (first-ever prescription ≤90 days before surgery date) and continuing users. We estimated 30-day cumulative mortality by the Kaplan-Meier method and corresponding mortality rate ratios (MRRs) using Cox proportional hazard regression, adjusting for potential confounders. RESULTS Of the 34 641 CRC patients included, 3966 (11.5%) had filled one or more prescriptions of glucocorticoids within the year before the surgery date. Thirty-day mortality among prevalent users of oral glucocorticoids was 15.0% vs. 7.3% among non-users [MRR = 1.28; 95% confidence interval (CI): 1.03, 1.58]. Among new users, the 30-day mortality was 17.8% (MRR = 1.92; 95% CI: 1.30, 2.83) while it was 14.2% among continuing users (MRR = 1.13; 95% CI: 0.88, 1.44). No associations were found for recent or former use of oral glucocorticoids nor for use of inhaled, intestinal-acting, and mixed glucocorticoids. CONCLUSIONS Prevalent use, particulary new use, of oral glucocorticoids was associated with markedly increased 30-day mortality after colorectal cancer surgery compared to patients not exposed to any glucocorticoids.
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Affiliation(s)
- E B Ostenfeld
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
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Ehrenstein V, Hernandez RK, Ulrichsen SP, Rungby J, Lash TL, Riis AH, Li L, Sørensen HT, Jick SS. Rosiglitazone use and post-discontinuation glycaemic control in two European countries, 2000-2010. BMJ Open 2013; 3:e003424. [PMID: 24068766 PMCID: PMC3787411 DOI: 10.1136/bmjopen-2013-003424] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To evaluate the impact of risk minimisation policies on the use of rosiglitazone-containing products and on glycaemic control among patients in Denmark and the UK. DESIGN, SETTING AND PARTICIPANTS We used population-based data from the Aarhus University Prescription Database (AUPD) in northern Denmark and from the General Practice Research Database (GPRD) in the UK. MAIN OUTCOME MEASURES We examined the use of rosiglitazone during its entire period of availability on the European market (2000-2010) and evaluated changes in the glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) levels among patients discontinuing this drug. RESULTS During 2000-2010, 2321 patients with records in AUPD used rosiglitazone in northern Denmark and 25 428 patients with records in GPRD used it in the UK. The proportion of rosiglitazone users among all users of oral hypoglycaemic agents peaked at 4% in AUPD and at 15% in GPRD in May 2007, the month of publication of a meta-analysis showing increased cardiovascular morbidity associated with rosiglitazone use. 12 months after discontinuation of rosiglitazone-containing products, the mean change in HbA1c was -0.16% (95% CI -3.4% to 3.1%) in northern Denmark and -0.17% (95% CI -0.21% to 0.13%) in the UK. The corresponding mean changes in FPG were 0.01 mmol/L (95% CI -7.3 to 7.3 mmol/L) and 0.03 mmol/L (95% CI -0.22 to 0.28 mmol/L). CONCLUSIONS Publication of evidence concerning the potential cardiovascular risks of rosiglitazone was associated with an irreversible decline in the use of rosiglitazone-containing products in Denmark and the UK. The mean changes in HbA1c and FPG after drug discontinuation were slight.
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Affiliation(s)
- V Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - R K Hernandez
- Boston Collaborative Drug Surveillance Program (BCDSP), Boston University School of Public Health, Lexington, Massachusetts, USA
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California, USA
| | - S P Ulrichsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - J Rungby
- Department of Biomedicine—Pharmacology, Aarhus University, Aarhus, Denmark
| | - T L Lash
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - A H Riis
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - L Li
- Boston Collaborative Drug Surveillance Program (BCDSP), Boston University School of Public Health, Lexington, Massachusetts, USA
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - S S Jick
- Boston Collaborative Drug Surveillance Program (BCDSP), Boston University School of Public Health, Lexington, Massachusetts, USA
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Ostenfeld EB, Erichsen R, Thorlacius-Ussing O, Riis AH, Sørensen HT. Use of systemic glucocorticoids and the risk of colorectal cancer. Aliment Pharmacol Ther 2013; 37:146-52. [PMID: 23116185 DOI: 10.1111/apt.12115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 07/26/2012] [Accepted: 10/09/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Systemic glucocorticoids are potent immunosuppressants, potentially facilitating carcinogenesis. Studies examining glucocorticoids and colorectal cancer risk are few. AIM To investigate the association between use of systemic glucocorticoids and colorectal cancer risk, both overall and by cancer stage (localised versus metastatic). METHODS We conducted a nested population-based case-control study in Northern Denmark (1.8 million people) using medical registries. The study included 14,158 patients with a first-time diagnosis of colorectal cancer from 1991 through 2010. Using risk set sampling, we identified 141,580 population controls, matched on age and gender. Logistic regression models were used to compute odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for covariates. RESULTS Frequent use of systemic glucocorticoids (defined as >2 prescriptions) was not associated with overall colorectal cancer risk [adjusted OR (aOR) = 0.93 (95% CI: 0.85-1.00)], compared with never/rare use (≤2 prescriptions). Associations according to duration of use and doses (quartiles of cumulative prednisolone equivalents) were also near the null. Examining colorectal cancer by stage, no substantial associations were found between long-term use (>5 years) of high-dose (>5500 mg) systemic glucocorticoids and localised [aOR = 1.12 (95% CI: 0.81-1.55)] or metastatic [aOR = 0.82 (95% CI: 0.59-1.14)] cancer. CONCLUSION Despite immunological and metabolic effects of frequent use of systemic glucocorticoids, which would be expected to increase colorectal cancer risk, we found no substantial association between the two.
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Affiliation(s)
- E B Ostenfeld
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.
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Abstract
BACKGROUND Venous thromboembolism has genetic determinants, but population-based data on familial risks are limited. OBJECTIVES To examine the familial risk of venous thromboembolism. METHODS We undertook a nationwide study of a cohort of patients with deep venous thrombosis or pulmonary embolism born after 1952. We used the Danish National Registry of Patients covering all Danish hospitals, for the years 1977 through 2009, to identify index cases of venous thromboembolism, and assessed the incidence among their siblings. We compared standardized incidence ratios (SIRs) of the observed and expected number of venous thromboembolism cases among siblings, using population-specific, gender-specific and age-specific incidence rates. RESULTS We identified 30,179 siblings of 19,599 cases of venous thromboembolism. The incidence among siblings was 2.2 cases per 1000 person-years, representing a relative risk of 3.08 (95% confidence interval [CI] 2.80-3.39) as compared with the general population. The risk was higher for both men (SIR 3.36, 95% CI 2.96-3.82) and women (SIR 2.81, 95% CI 2.45-3.23). The risk was similar among siblings of index cases with venous thrombosis and those of index cases with pulmonary embolism. CONCLUSION Venous thromboembolism has a strong familial component.
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Affiliation(s)
- H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
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Cronin-Fenton DP, Riis AH, Lash TL, Dalton SO, Friis S, Robertson D, Sørensen HT. Antidepressant use and colorectal cancer risk: a Danish population-based case-control study. Br J Cancer 2010; 104:188-92. [PMID: 20877356 PMCID: PMC3039807 DOI: 10.1038/sj.bjc.6605911] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Earlier research suggests that use of selective serotonin reuptake inhibitors (SSRIs), but not tricyclic antidepressants (TCAs), reduces the risk of colorectal cancer (CRC). Methods: We conducted a population-based case–control study to investigate the association between antidepressant use and CRC risk. Cases were diagnosed with a first primary CRC from 1991 through 2008. We selected 10 population controls matched to cases on sex, birth year, and residence from the Danish Civil Registration System using risk-set sampling. We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) associating antidepressant use with colorectal cancer occurrence, controlling for potential confounders. Results: The study included 9979 cases and 99 790 controls. We found no notable reduction in CRC risk in ever users (⩾2 prescriptions) of TCAs (OR=0.94; 95% CI: 0.84, 1.05), SSRIs (OR=0.97; 95% CI: 0.90, 1.05), or other antidepressants (OR=0.95; 95% CI: 0.83, 1.07). Associations for recent and former use of antidepressants were also near null. Intensity of antidepressant use (number of pills divided by total duration of use), regardless of duration, was not associated with CRC risk. Conclusions: We found no evidence that antidepressant use substantially reduces the risk of colorectal cancer.
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Affiliation(s)
- D P Cronin-Fenton
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark.
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