骨质疏松症患者:用唑来膦酸代替阿仑膦酸治疗与缺血性卒中的高风险相关——一项真实世界的全球研究

IF 1.8 4区 医学 Q3 NEUROSCIENCES
Sien-Yu Ko MD , Jun-Fu Lin MSc , Ching-Heng Lin Ph.D , Yuan-Yang Cheng Ph.D
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引用次数: 0

摘要

目的:我们的目的是确定长期使用双膦酸盐是否会增加普通人群和已有心血管疾病的个体缺血性卒中的风险。方法:这是一项遵循STROBE检查表的回顾性队列研究。从2002年1月1日至2022年12月31日,我们使用TriNetX数据评估了1,905,808例年龄≥55岁的骨质疏松症患者接受阿仑膦酸或唑来膦酸治疗后缺血性卒中的发生率。患者按年龄和性别分层,并使用倾向评分匹配来减少混杂。分析集中在一般人群和已有房颤或动脉粥样硬化的亚组。以阿仑膦酸服用者为参照,计算索引日期后5年、10年和15年的风险比(HR = 1)。Kaplan-Meier分析用于估计无事件生存率。结果:在5年、10年和15年的随访中,与阿仑膦酸相比,唑来膦酸与普通人群、女性和没有房颤或主动脉粥样硬化的患者缺血性卒中风险增加相关。15年无卒中生存率Kaplan-Meier分析显示唑来膦酸组为85.9%,阿仑膦酸组为89.9%,风险比为1.22(95%可信区间为1.11-1.34)。结论:与阿仑膦酸相比,在普通人群、女性和没有房颤或主动脉粥样硬化的患者中,唑来膦酸与缺血性卒中风险增加相关。因此,我们建议对这些相对脆弱的人群进行长期随访和严格的卒中危险因素管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Patients with osteoporosis: Treatment with zoledronic acid instead of alendronic acid is associated with a higher risk of ischemic stroke - A real-world global study

Aims

We aimed to determine whether prolonged use of bisphosphonates increases the risk of ischemic stroke in the general population and in individuals with pre-existing cardiovascular conditions.

Methods

This is a retrospective cohort study adhering to the STROBE checklist. We assessed ischemic stroke incidence following alendronic or zoledronic acid treatment in 1,905,808 patients aged ≥55 years with osteoporosis using TriNetX data from January 1, 2002, to December 31, 2022. Patients were stratified by age and gender, and propensity score matching was used to minimize confounding. Analyses focused on the general population and subgroups with pre-existing atrial fibrillation or atherosclerosis. Hazard ratios were calculated at 5, 10, and 15 years post-index date, using alendronic acid users as the reference (HR = 1). The Kaplan–Meier analysis was used to estimate event-free survival over time.

Results

Zoledronic acid was associated with an increased ischemic stroke risk at 5, 10, and 15 years of follow-up compared to alendronic acid in the general population, in women, and in patients without pre-existing atrial fibrillation or aortic atherosclerosis. The Kaplan–Meier analysis of stroke-free survival at 15 years showed 85.9 % in the zoledronic acid group and 89.9 % in the alendronic acid group, with a hazard ratio of 1.22 (95 % confidence interval, 1.11–1.34).

Conclusions

Zoledronic acid was associated with an increased ischemic stroke risk compared to alendronic acid in the general population, in women, and in patients without pre-existing atrial fibrillation or aortic atherosclerosis. Therefore, we recommend long-term follow-up and strict management of stroke risk factors in these relatively vulnerable populations.
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来源期刊
CiteScore
5.00
自引率
4.00%
发文量
583
审稿时长
62 days
期刊介绍: The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.
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