抗吸收药物的使用与急性心血管风险无关：一项观察性研究。
Antiresorptive Medication Use Is not Associated With Acute Cardiovascular Risk: An Observational Study.
机构信息
Skeletal diseases Program, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia.
School of Population Health, Faculty of Medicine and Health, UNSW Sydney, NSW 2052, Australia.
出版信息
J Clin Endocrinol Metab. 2023 Apr 13;108(5):e110-e119. doi: 10.1210/clinem/dgac669.
CONTEXT
Bisphosphonates have been reported to be cardioprotective in some, but not all, studies. It is unknown whether denosumab (Dmab) use protects against cardiovascular events (CVEs).
OBJECTIVE
To determine whether oral bisphosphonate (oBP) or Dmab use is associated with CVEs in persons with incident fracture.
METHODS
Participants with an incident minimal trauma fracture from the Sax Institute's 45 and Up Study, a population-based cohort from NSW, Australia, were followed between 2005/2009 and 2017. Questionnaire data were linked to hospital admissions (Admitted Patients Data Collection [APDC]) by the Centre for Health Record Linkage). Medicare Benefit Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data sets were provided by Services Australia. Data was stored in a secure computing environment (Secure Unified Research Environment). Fractures, CVEs, and comorbidities were identified from the APDC and oBP and Dmab medication from the PBS. oBP and Dmab users were matched to never users (NoRx) by propensity scores. The main outcome measures were association between oBP and Dmab with CVE (acute myocardial infarction, unstable angina, cerebrovascular accident, and transient ischemic attack) and were determined using a stratified Cox's proportional hazards model.
RESULTS
There were 880 pairs of oBP and NoRx (616 women) and 770 pairs of Dmab and NoRx (615 women) followed for ∼4.3 years. CVE risk was similar for oBP and NoRx Hazard Ratios (HR) women, 0.88 [95% CI 0.65-1.18]; men, 1.07 [95% CI 0.72-1.57]). Similar findings were obtained for Dmab (Hazard Ratios (HR) women, 1.08 [95% CI 0.78-1.50]; men, 1.55 [95% CI 0.96-2.48]).
CONCLUSION
oBP and Dmab use was not associated with CVEs.
背景
在一些研究中，双磷酸盐被报道具有心脏保护作用，但并非所有研究都如此。目前尚不清楚地舒单抗（Dmab）的使用是否能预防心血管事件（CVE）。
目的
确定初发骨折患者中口服双膦酸盐（oBP）或 Dmab 的使用是否与 CVE 相关。
方法
参与者来自澳大利亚新南威尔士州的 Sax 研究所的 45 岁及以上研究的一个基于人群的队列，该研究中发生了轻微创伤性骨折。从 2005/2009 年至 2017 年对参与者进行了随访。通过健康记录链接中心（Centre for Health Record Linkage）将问卷数据与医院入院记录（Admitted Patients Data Collection [APDC]）相关联。医疗保险福利计划（Medicare Benefit Schedule [MBS]）和药品福利计划（Pharmaceutical Benefits Scheme [PBS]）数据集由澳大利亚服务局提供。数据存储在安全的计算环境（Secure Unified Research Environment）中。APDC 中确定了骨折、CVE 和合并症，PBS 中确定了 oBP 和 Dmab 药物的使用情况。通过倾向评分将 oBP 和 Dmab 使用者与从未使用过这些药物的人（NoRx）进行匹配。使用分层 Cox 比例风险模型确定 oBP 和 Dmab 与 CVE（急性心肌梗死、不稳定型心绞痛、脑血管意外和短暂性脑缺血发作）之间的关联。
结果
共纳入了 880 对使用 oBP 和未使用 oBP（616 名女性）以及 770 对使用 Dmab 和未使用 Dmab（615 名女性）的患者，平均随访了约 4.3 年。oBP 和 NoRx 组女性的 CVE 风险相似（危险比 [HR]，0.88 [95%置信区间，0.65-1.18]；男性，1.07 [95%置信区间，0.72-1.57]）。Dmab 组也得到了类似的结果（女性 HR，1.08 [95%置信区间，0.78-1.50]；男性 HR，1.55 [95%置信区间，0.96-2.48]）。
结论
oBP 和 Dmab 的使用与 CVE 无关。
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