Use of antihypertensive drugs and risk of skin cancer Schmidt, S.A.J.; Schmidt, M.; Mehnert, F. ...
Journal of the European Academy of Dermatology and Venereology,
August 2015, Letnik:
29, Številka:
8
Journal Article
Recenzirano
Odprti dostop
Background
Several antihypertensive drugs are photosensitizing and may therefore act as cocarcinogens with ultraviolet radiation.
Objective
To examine whether antihypertensive drug use is associated ...with squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and malignant melanoma (MM).
Methods
We used population‐based databases to conduct a case–control study including all first‐time cases of SCC (n = 2282), BCC (n = 17 242), and MM (n = 3660) in northern Denmark, 1991–2010. We matched approximately 10 controls (n = 231 743) to each case by age, sex and county using risk‐set sampling. We used conditional logistic regression to compute odds ratios (ORs) for skin cancer with 95% confidence intervals comparing ever users of antihypertensives (>2 previous prescriptions) with non‐users (≤2 previous prescriptions). We adjusted for comorbidity and comedications. We further analysed use by duration (short term: <5 years; long term: ≥5 years) and intensity (low intensity or high intensity: <50% or ≥50% prescription coverage during total duration of use, respectively).
Results
Ever users of diuretics were at increased risk of SCC (OR 1.19; 1.06–1.33), driven by potassium‐sparing agents alone (OR 1.40; 1.09–1.80) or with low‐ceiling diuretics (OR 2.68; 2.24–3.21) and by long‐term use (OR 1.41; 1.16–1.72 at low intensity; OR 1.44; 0.98–2.14 at high intensity). Ever users of sulphonamides (OR 1.49; 1.04–2.12) and non‐aldosterone antagonist potassium‐sparing agents (OR 2.26; 0.85–6.01) were at increased MM risk. The latter was also associated with BCC (OR 1.47; 1.00–2.17), as was low‐ceiling diuretics combined with potassium‐sparing agents (OR 1.23; 1.12–1.35). Long‐term, low‐intensity (OR 1.53; 1.05–2.23) and high‐intensity (OR 1.44; 0.56–3.69) angiotensin receptor blocker use was associated with MM. Estimates for angiotensin‐converting enzyme inhibitors, β‐blockers, and calcium channel blockers were inconsistent or weak (<20% increased).
Conclusion
Long‐term angiotensin receptor blocker use was associated with risk of MM. Moreover, long‐term diuretic use was associated with SCC risk, driven by potassium‐sparing agents alone or in combination with low‐ceiling diuretics.
Summary Objectives To evaluate implant survival following primary total hip replacement (THR) in younger patients. To describe the diversity in use of cup-stem implant combinations. Design 29,558 ...primary THRs osteoarthritis (OA) patients younger than 55 years of age performed from 1995 through 2011 were identified using the Nordic Arthroplasty Registry Association database. We estimated adjusted relative risk (aRR) of revision with 95% confidence interval (CI) using Cox regression. Results In general, no difference was observed between uncemented and cemented implants in terms of risk of any revision. Hybrid implants were associated with higher risk of any revision (aRR = 1.3, CI: 1.1–1.5). Uncemented implants led to a reduced risk of revision due to aseptic loosening (aRR = 0.5, CI: 0.5–0.6), whereas the risk was similar for hybrid and cemented implants. Compared with cemented implants, both uncemented and hybrid implants led to elevated risk of revision due to other causes, as well as elevated risk of revision due to any reason within 2 years. 183 different uncemented cup-stem implant combinations were registered in Denmark, of these, 172 were used in less than 100 operations which is similar to Norway, Sweden and Finland. Conclusions Uncemented implants perform better in relation to long-term risk of aseptic loosening, whereas both uncemented and hybrid rather than cemented implants in patients younger than 55 years had more short-term revisions because problems due to dislocation, periprosthetic fracture and infection has not yet been completely solved. The vast majority of cup-stem combinations were used in very few operations.
Summary Objective To estimate and compare the lifetime risk of total knee replacement surgery (TKR) for osteoarthritis (OA) between countries, and over time. Method Data on primary TKR procedures ...performed for OA in 2003 and 2013 were extracted from national arthroplasty registries in Australia, Denmark, Finland, Norway and Sweden. Life tables and population data were also obtained for each country. Lifetime risk of TKR was calculated for 2003 and 2013 using registry, life table and population data. Results Marked international variation in lifetime risk of TKR was evident, with females consistently demonstrating the greatest risk. In 2013, Finland had the highest lifetime risk for females (22.8%, 95%CI 22.5–23.1%) and Australia had the highest risk for males (15.4%, 95%CI 15.1–15.6%). Norway had the lowest lifetime risk for females (9.7%, 95%CI 9.5–9.9%) and males (5.8%, 95%CI 5.6–5.9%) in 2013. All countries showed a significant rise in lifetime risk of TKR for both sexes over the 10-year study period, with the largest increases observed in Australia (females: from 13.6% to 21.1%; males: from 9.8% to 15.4%). Conclusions Using population-based data, this study identified significant increases in the lifetime risk of TKR in all five countries from 2003 to 2013. Lifetime risk of TKR was as high as 1 in 5 women in Finland, and 1 in 7 males in Australia. These risk estimates quantify the healthcare resource burden of knee OA at the population level, providing an important resource for public health policy development and healthcare planning.
It remains disputed how much the risk of Staphylococcus aureus bacteraemia (SAB) is increased in patients with rheumatoid arthritis (RA), and the extent to which orthopaedic implants explain the ...risk. We assessed SAB incidence rates (IRs) and incidence rate ratios (IRRs), comparing RA patients with a general population cohort (GPC) and individuals with versus without orthopaedic implants.
Danish residents aged ≥ 18 years without prior RA or SAB (=GPC) were followed up for RA and microbiologically verified SAB events (1996-2017). IRRs were calculated by age- and sex-stratified Poisson regression adjusted for age, comorbidities, calendar year, and socioeconomic status.
The GPC comprised 5 398 690 individuals. We identified 33 567 incident RA patients (=RA cohort) (median follow-up 7.3 years, IQR 3.6-12.3). We observed 25 023 SAB events (n = 224 in the RA cohort). IRs per 100 000 person-years were 81.0 (RA cohort) and 29.9 (GPC). IRs increased with age. Adjusted IRRs in 18-59-year-old RA patients were 2.6 (95% confidence interval 1.8-3.7) for women and 1.8 (1.1-3.1) for men, compared with same sex and age group GPC. IRRs declined with age. Compared with the GPC without implants, IRRs for RA patients with implants ranged from 1.9 (1.3-2.8) (women ≥ 70 years) to 5.3 (2.2-12.8) (18-59-year-old men).
In this nationwide registry-based cohort study RA was a risk factor for SAB, and orthopaedic implants further increased the risk. Clinicians should be aware of potential SAB in patients with RA and orthopaedic implants.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
We examined the risk of thrombotic and major bleeding events in patients undergoing total hip and knee replacement (THR and TKR) treated with thromboprophylaxis, using nationwide population-based ...databases. We identified 83 756 primary procedures performed between 1997 and 2011. The outcomes were symptomatic venous thromboembolism (VTE), myocardial infarction (MI), stroke, death and major bleeding requiring hospitalisation within 90 days of surgery. A total of 1114 (1.3%) and 483 (0.6%) patients experienced VTE and bleeding, respectively. The annual risk of VTE varied between 0.9% and 1.6%, and of bleeding between 0.4% and 0.8%. The risk of VTE and bleeding was unchanged over a 15-year period. A total of 0.7% of patients died within 90 days, with a decrease from 1% in 1997 to 0.6% in 2011 (p < 0.001). A high level of comorbidity and general anaesthesia were strong risk factors for both VTE and bleeding, with no difference between THR and TKR patients. The risk of both MI and stroke was 0.5%, which remained unchanged during the study period. In this cohort study of patients undergoing THR and TKR patients in routine clinical practice, approximately 3% experienced VTE, MI, stroke or bleeding. These risks did not decline during the 15-year study period, but the risk of dying fell substantially.
BACKGROUND:Data on the risk factors for venous thromboembolism among patients undergoing total hip replacement and receiving pharmacological thromboprophylaxis are limited. The purpose of this study ...was to examine potential patient-related risk factors for venous thromboembolism following total hip replacement in a nationwide follow-up study.
METHODS:Using medical databases, we identified all patients who underwent primary total hip replacement and received pharmacological thromboprophylaxis in Denmark from 1995 to 2006. The outcome measure was hospitalization with venous thromboembolism within ninety days of surgery. We considered age, sex, indication for primary total hip replacement, calendar year of surgery, and comorbidity history as potential risk factors.
RESULTS:The overall rate of hospitalization for venous thromboembolism within ninety days following a primary total hip replacement was 1.02% (686 hospitalizations after 67,469 procedures) at a median of twenty-two days. The incidence of symptomatic deep venous thrombosis and of nonfatal pulmonary embolism was 0.7% (499 of 67,469) and 0.3% (205 of 67,469), respectively. The incidence of death due to venous thromboembolism or from all causes was 0.05% (thirty-eight patients) and 1.0% (678 patients), respectively. Patients with rheumatoid arthritis had a reduced relative risk for venous thromboembolism compared with patients with primary osteoarthritis (adjusted relative risk = 0.47; 95% confidence interval, 0.25 to 0.90). Patients with a high score on the Charlson comorbidity index had an increased relative risk for venous thromboembolism compared with patients with a low score (adjusted relative risk = 1.45; 95% confidence interval, 1.02 to 2.05). Patients with a history of cardiovascular disease (relative risk = 1.40; 95% confidence interval, 1.15 to 1.70) or prior venous thromboembolism (relative risk = 8.09; 95% confidence interval, 6.07 to 10.77) had an increased risk for venous thromboembolism compared with patients without that history.
CONCLUSIONS:The cumulative incidence of a venous thromboembolism within ninety days of surgery among patients with total hip replacement receiving pharmacological thromboprophylaxis was 1%. This information on the associated risk factors could be used to better anticipate the risk of venous thromboembolism for an individual patient.
LEVEL OF EVIDENCE:Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
Summary
Background
Proton pump inhibitors (PPIs) may activate the immune system and cause asthma.
Aim
To investigate the association of prenatal exposure to PPIs and histamine 2‐receptor antagonists ...(H2RAs) with risk of asthma.
Methods
In this cohort study, 197 060 singletons born between 1996 and 2008 in northern Denmark were followed until the end of 2009. Data were obtained through Danish medical registries. Asthma in offspring was defined as at least two prescriptions of both a β‐agonist and an inhaled glucocorticoid and/or a hospital diagnosis of asthma during the follow‐up. Cox proportional‐hazard regression was used to compute incidence rate ratios, adjusting for covariates.
Results
A total of 2238 (1.1%) children were prenatally exposed to PPIs and 24 506 (12.4%) children developed asthma during follow‐up (median follow‐up = 6.8 years). The adjusted IRR (aIRR) of asthma associated with prenatal exposure to PPIs was 1.41 (95% confidence interval (CI): 1.27–1.56), compared with those unexposed. The association did not vary by trimester of exposure, and prenatal exposure to H2RAs was associated with similar increase in risk. The aIRR for maternal PPI and H2RA use in the year after, but not during pregnancy was 1.32 (95% CI: 1.20–1.46) and 1.13 (0.93–1.36), respectively, compared with non‐use during and in the year after pregnancy.
Conclusions
Prenatal exposure to both PPIs and H2RAs was associated with an increased risk of asthma in our study. Because the observed association is not drug specific and also observed for maternal postnatal use it may be explained by a ‘class effect’ or maternal underlying condition.
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