Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
J Formos Med Assoc. 2021 Nov;120(11):1957-1966. doi: 10.1016/j.jfma.2020.12.014. Epub 2020 Dec 25.
BACKGROUND/PURPOSE: Bisphosphonates (BPs) impact on the survival and cardiovascular safety of osteoporosis patients after acute coronary syndrome (ACS) or acute ischemic stroke (AIS) was evaluated.
A nationwide epidemiological study was conducted using the Taiwan National Health Insurance Research Database from 2000 to 2010. From the 1456 osteoporosis patients with previous ACS or AIS, mortality and cardiovascular safety was compared between 464 patients who used BPs and 464 patients who did not. Primary outcomes included all-cause mortality, and major adverse cardiovascular events.
The BPs group had a lower risk of all-cause mortality than the control group after the 8-year follow-up (HR, 0.64; 95% CI, 0.46-0.88; P = 0.006). The risks of myocardial infarction, ischemic stroke, cardiovascular death, hospitalization for heart failure or other causes of mortality were similar across groups. However, there was a higher risk of hospitalization for atrial fibrillation in the BPs group than the control group (HR, 1.76; 95% CI, 1.26-2.46; P = 0.001).
Among osteoporosis patients after ACS or AIS, BPs use was associated with a reduced risk of all-cause mortality. However, patients with previous cardiovascular disease who received BP treatment should be careful about the risk of atrial fibrillation.
背景/目的：评估双膦酸盐（BPs）对急性冠状动脉综合征（ACS）或急性缺血性脑卒中（AIS）后骨质疏松症患者的生存和心血管安全性的影响。
本研究采用 2000 年至 2010 年台湾全民健康保险研究数据库进行了一项全国性的流行病学研究。从之前患有 ACS 或 AIS 的 1456 例骨质疏松症患者中，比较了 464 例使用 BPs 的患者和 464 例未使用 BPs 的患者的死亡率和心血管安全性。主要结局包括全因死亡率和主要不良心血管事件。
在 8 年的随访后，BPs 组的全因死亡率低于对照组（HR，0.64；95%CI，0.46-0.88；P=0.006）。各组之间心肌梗死、缺血性脑卒中、心血管死亡、因心力衰竭或其他原因住院导致的死亡率风险相似。然而，BPs 组因心房颤动住院的风险高于对照组（HR，1.76；95%CI，1.26-2.46；P=0.001）。
在 ACS 或 AIS 后患有骨质疏松症的患者中，BPs 的使用与全因死亡率降低相关。然而，接受 BP 治疗的有既往心血管疾病的患者应注意心房颤动的风险。
