丙戊酸的使用与心肌梗死后心力衰竭发展的关系:两项回顾性病例对照研究的 Meta 分析。

IF 2.5 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Joseph D English, Shuo Tian, Zhong Wang, Jasmine A Luzum
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引用次数: 0

摘要

背景:尽管治疗方法不断进步,心肌梗塞(MI)仍然是全球发病率和死亡率的重要原因。我们的团队以前曾证明,心肌梗死后给大鼠服用丙戊酸(VPA)可保护心脏。本研究的目的是调查使用 VPA 与人类心肌梗死后心力衰竭(HF)发展的关系:本研究是对两项回顾性病例对照研究进行的随机效应荟萃分析,这两项研究是从电子健康记录(密歇根医学)和理赔数据(OptumInsight)中收集的。根据多种人口统计学和临床特征,将心肌梗死时开具 VPA 有效处方的病例与心肌梗死时未服用 VPA 的对照组按 1:4 进行配对。主要研究结果--心房颤动发生时间--采用Fine-Gray竞争风险模型对任何VPA处方与无VPA处方进行了分析。还进行了一项探索性分析,以评估不同 VPA 剂量(≥1000 毫克/天 vs 结果)之间的关联:数据集共包括 1313 名患者(249 例病例和 1064 例对照)。在荟萃分析中,心肌梗死期间任何剂量的 VPA 对心肌梗死后发生 HF 都有保护作用(HR = 0.87;95% CI = 0.72-1.01)。然而,当按剂量分层时,高剂量 VPA(≥1000 毫克/天)与心肌梗死后患心房颤动的风险降低 30% 显著相关(HR = 0.70;95% CI = 0.49-0.91),而低剂量 VPA(结论:VPA 剂量≥1000 毫克/天)与心肌梗死后患心房颤动的风险降低 30% 显著相关(HR = 0.70;95% CI = 0.49-0.91):VPA 剂量≥1000 毫克/天可提供心肌梗死后的心肌保护,从而降低心房颤动的发病率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Association of Valproic Acid Use With Post-Myocardial Infarction Heart Failure Development: A Meta-Analysis of Two Retrospective Case-Control Studies.

Association of Valproic Acid Use With Post-Myocardial Infarction Heart Failure Development: A Meta-Analysis of Two Retrospective Case-Control Studies.

Association of Valproic Acid Use With Post-Myocardial Infarction Heart Failure Development: A Meta-Analysis of Two Retrospective Case-Control Studies.

Association of Valproic Acid Use With Post-Myocardial Infarction Heart Failure Development: A Meta-Analysis of Two Retrospective Case-Control Studies.

Background: Despite advances in treatments, myocardial infarction (MI) remains a significant cause of morbidity and mortality worldwide. Our team has previously shown that valproic acid (VPA) is cardio-protective when administered to rats post-MI. The aim of this study was to investigate the association of VPA use with post-MI heart failure (HF) development in humans.

Methods: This study was a random effects meta-analysis of two retrospective case-control studies collected from electronic health record (Michigan Medicine) and claims data (OptumInsight). Cases with an active prescription for VPA at the time of their MI were matched 1:4 to controls not taking VPA at the time of their MI by multiple demographic and clinical characteristics. The primary outcome, time-to-HF development, was analyzed using the Fine-Gray competing risks model of any VPA prescription versus no VPA prescription. An exploratory analysis was conducted to evaluate the association of different VPA doses (≥1000 mg/day vs <1000 mg/day vs 0 mg/day VPA).

Results: In total, the datasets included 1313 patients (249 cases and 1064 controls). In the meta-analysis, any dose of VPA during an MI tended to be protective against incident HF post-MI (HR = 0.87; 95% CI = 0.72-1.01). However, when stratified by dose, high-dose VPA (≥1000 mg/day) significantly associated with 30% reduction in risk for HF post-MI (HR = 0.70; 95% CI = 0.49-0.91), whereas low-dose VPA (<1000 mg/day) did not (HR = 0.95; 95% CI = 0.78-1.13).

Conclusion: VPA doses ≥1000 mg/day may provide post-MI cardio-protection resulting in a reduced incidence of HF.

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来源期刊
CiteScore
6.00
自引率
0.00%
发文量
33
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Pharmacology and Therapeutics (JCPT) is a peer-reviewed journal that publishes original basic human studies, animal studies, and bench research with potential clinical application to cardiovascular pharmacology and therapeutics. Experimental studies focus on translational research. This journal is a member of the Committee on Publication Ethics (COPE).
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