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Papers by diana barreira
Journal of Clinical Medicine, Aug 14, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Annals of the Rheumatic Diseases, May 30, 2023
Journal of the American Heart Association, Jan 18, 2017
There is controversy surrounding the risk of ischemic stroke associated with the use of calcium s... more There is controversy surrounding the risk of ischemic stroke associated with the use of calcium supplements either in monotherapy or in combination with vitamin D. A nested case-control study was performed with patients aged 40 to 89 years old, among whom a total of 2690 patients had a first episode of nonfatal ischemic stroke and for which 19 538 controls were randomly selected from the source population and frequency-matched with cases for age, sex, and calendar year. Logistic regression provided the odds ratios while adjusting for confounding factors. A sensitivity analysis was performed by restricting to patients who were new users of calcium supplements as either monotherapy or with vitamin D. Calcium supplementation with vitamin D was not associated with an increased risk of ischemic stroke (odds ratio 0.85; 95% confidence interval, 0.67-1.08) in the population as a whole or under any of the conditions examined (dose, duration, background cardiovascular risk, sex, or age). Cal...
Frontiers in Pharmacology
Background: Bisphosphonates have been reported to increase the risk of atrial fibrillation. There... more Background: Bisphosphonates have been reported to increase the risk of atrial fibrillation. Therefore, it is conceivable that they may increase the risk of cardioembolic ischemic stroke (IS). However, most epidemiological studies carried out thus far have not shown an increased risk of IS, though none separated by the main pathophysiologic IS subtype (cardioembolic and non-cardioembolic) which may be crucial. In this study, we tested the hypothesis that the use of oral bisphosphonates increases specifically the risk of cardioembolic IS, and explored the effect of treatment duration, as well as the potential interaction between oral bisphosphonates and calcium supplements and anticoagulants.Methods: We performed a case-control study nested in a cohort of patients aged 40–99 years, using the Spanish primary healthcare database BIFAP, over the period 2002-2015. Incident cases of IS were identified and classified as cardioembolic or non-cardioembolic. Five controls per case were randoml...
Journal of Clinical Medicine, Jan 18, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Revista Española de Quimioterapia, 2021
Introduction. Several factors have been associated with the prognosis of prosthetic joint infecti... more Introduction. Several factors have been associated with the prognosis of prosthetic joint infection (PJI) treated with surgical debridement, antibiotic therapy, and implant retention (DAIR). There is no evidence about the right empirical antibiotic treatment when the causal microorganism is not still identified. Material and methods. We conducted a retrospective observational study in patients with PJI treated with DAIR between 2009 and 2018 in our center. We analyze the risk factors related with their prognosis and the influence of active empirical antibiotic therapy against causative microorganisms in final outcomes. Results. A total of 80 PJI cases treated with DAIR, from 79 patients (58.7% women, mean age 76.3 years), were included in the study period. Among the cases in which empirical antibiotic therapy were active against the causative microorganisms, the success rate was 46/65 (69.2%) vs 1/15 when not (6.7%, OR 31.5, p = 0.001). Factors related to the success or failure of t...
![Research paper thumbnail of [Counseling: a tool for enhancing the communication with the patient]](https://attachments.academia-assets.com/100321139/thumbnails/1.jpg)
](Farmacia hospitalaria : órgano oficial de expresión científica de la Sociedad Española de Farmacia Hospitalaria
Counseling is a technique used in psychology that has shown a major impact on health: in deep, it... more Counseling is a technique used in psychology that has shown a major impact on health: in deep, it is the methodology recommended by the Worl Health Organization to help HIV-infected patients. Although it has been translated to spanish by assisted counseling or helping relationship, counseling covers a broader concept. It is defined as an interactive process based on communication in which the clinician helps the patients to think about their own health and to take appropiate decisions based on their values and interests. In short, counseling is a tool to enhance communication with the patient, resulting very useful during clinical interview in pharmaceutical care programs in order to improve pharmacotherapy and patient safety.
Therapeutic Advances in Musculoskeletal Disease
Background: Several studies have reported that the use of chondroitin sulphate (CS) and glucosami... more Background: Several studies have reported that the use of chondroitin sulphate (CS) and glucosamine may reduce the risk of acute myocardial infarction. Although it is thought that this potential benefit could be extended to ischaemic stroke (IS), the evidence is scarce. Objective: To test the hypothesis that the use of prescription glucosamine or CS reduces the risk of IS. Design: Case–control study nested in an open cohort. Methods: Patients aged 40–99 years registered in a Spanish primary healthcare database (BIFAP) during the 2002–2015 study period. From this cohort, we identified incident cases of IS, applying a case-finding algorithm and specific validation procedures, and randomly sampled five controls per case, individually matched with cases by exact age, gender and index date. Adjusted odds ratios (AORs) and 95% confidence interval (CI) were computed through a conditional logistic regression. Only new users of glucosamine or CS were considered. Results: A total of 13,952 in...
Journal of Clinical Medicine, Mar 10, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Annals of the Rheumatic Diseases, 2021
There is some evidence from epidemiological studies suggesting that CS and glucosamine could play... more There is some evidence from epidemiological studies suggesting that CS and glucosamine could play a role in cardiovascular disease (CVD) prevention (1-4).Studies to date have included prevalent users, therefore a bias that overestimates protection cannot be excluded.To test the hypothesis that chondroitin sulphate (CS) or glucosamine reduce the risk of acute myocardial infarction (AMI).Case-control study nested in a primary cohort composed of patients aged 40 to 99 years, with at least one year of follow-up in the BIFAP database during the 2002-2015 study period. From this cohort of patients, we identified incident cases of AMI and randomly selected five controls per case, matched by exact age, gender, and index date. Adjusted odds ratios (AOR) and their corresponding 95% confidence interval (CI)) were calculated through a conditional logistic regression. Only new users of CS or glucosamine were considered.A total of 23,585 incident cases of AMI and 117,405 controls were included. T...
Heart, 2021
ObjectiveTo assess the relationship between influenza vaccination and risk of a first acute myoca... more ObjectiveTo assess the relationship between influenza vaccination and risk of a first acute myocardial infarction (AMI) in the general population by different epidemic periods.MethodsThis is a population-based case–control study carried out in BIFAP (Base de datos para la investigación farmacoepidemiológica en atención primaria), over 2001–2015, in patients aged 40–99 years. Per each incident AMI case, five controls were randomly selected, individually matched for exact age, sex and index date (AMI diagnosis). A patient was considered vaccinated when he/she had a recorded influenza vaccination at least 14 days before the index date within the same season. The association between influenza vaccination and AMI risk was assessed through a conditional logistic regression, computing adjusted ORs (AOR) and their respective 95% CIs. The analysis was performed overall and by each of the three time epidemic periods per study year (pre-epidemic, epidemic and postepidemic).ResultsWe identified...
Medicina Clínica, 2020
Resumen Antecedentes y objetivo El uso del acido acetilsalicilico a dosis bajas (AAS-DB) en preve... more Resumen Antecedentes y objetivo El uso del acido acetilsalicilico a dosis bajas (AAS-DB) en prevencion primaria es motivo de controversia, pero se desconoce su magnitud en Espana. El objetivo del estudio fue estimar la proporcion de pacientes a los que se prescribio AAS-DB como prevencion primaria durante el periodo 2002-2015 e identificar sus caracteristicas. Metodos En una muestra de la base de datos de atencion primaria para la investigacion farmacoepidemiologica (BIFAP) se obtuvo la proporcion de personas con prescripciones de AAS-DB, excluyendo los pacientes con enfermedad vascular oclusiva, fibrilacion auricular y cancer. Las proporciones se estandarizaron para la poblacion espanola de 40-99 anos. Se construyo un modelo de regresion logistica para identificar los factores asociados a la prescripcion de AAS-DB y se estimo su prevalencia segun la combinacion de dichos factores. Resultados Se incluyeron 102.850 sujetos, 6.198 de ellos usuarios de AAS-DB. La prevalencia estandarizada fue del 2,21% al comienzo del periodo y del 3,57% al final. La prescripcion aumento con la edad. Los factores mas asociados fueron diabetes (OR = 3,26; IC 95%: 3,07-3,47), dislipidemia (OR = 2,08; 1,96-2,21), insuficiencia cardiaca (OR = 2,02; 1,72-2,37) e hipertension (OR = 1,78; 1,67-1,90). La prevalencia de prescripcion de AAS-DB alcanzo el 33,7% en mayores de 70 anos con diabetes, hipertension y dislipidemia. Conclusiones En el periodo estudiado la prescripcion de AAS-DB para prevencion primaria en Espana fue baja en la poblacion general, pero elevada en pacientes diabeticos mayores de 70 anos con factores de riesgo adicionales. Despues de anos de controversia parece necesario adecuar el uso de este farmaco en prevencion primaria a las recomendaciones actuales.
Alimentary Pharmacology & Therapeutics, 2019
Background: Inflammation and overexpression of cyclooxygenase-2 (COX-2) have been described to pl... more Background: Inflammation and overexpression of cyclooxygenase-2 (COX-2) have been described to play a key role in the progression from nonpathologic intestinal mucosa to colorectal cancer (CRC). Aims: To assess the chemoprotective effect of non-aspirin nonsteroidal antiinflammatory drugs (NA-NSAIDs) under different patterns of use in a Mediterranean population and to explore the potential effect of symptomatic slow-acting drugs for osteoarthritis (SYSADOAs; chondroitin sulfate and glucosamine) and metamizole (or dipyrone), also reported to influence COX-2 activity. Methods: We performed a case-control study nested in a cohort extracted from the primary care database, BIFAP. From 2001 to 2014, we included 15 491 incident cases and 60 000 random controls. To estimate the association between the drugs of interest and CRC, we built logistic regression models to compute the adjusted-odds ratios (AOR) and 95% confidence intervals (CI). Results: NA-NSAIDs use was associated with a reduced risk of CRC (AOR = 0.67; 95% CI: 0.63-0.71) and increased linearly with duration of treatment (p for trend <0.001). The effect diminished upon discontinuation but persisted statistically significant up to 1 year. All individual NA-NSAIDs examined showed a decreased risk. The concomitant use of proton-pump inhibitors (PPI) had no impact on the protective effect of NA-NSAIDs; AOR PPI + NSAID = 0.64; 0.58-0.71. SYSADOA use was associated with a reduced risk (0.79; 0.69-0.90) but disappeared after the exclusion of NSAID users during the previous 1 or 3 years (0.85; 0.70-1.04 and 1.00; 0.76-1.31 respectively). Metamizole did not show a chemoprotective effect. Conclusions: NA-NSAID use is associated with a duration-dependent risk reduction of CRC not shared by SYSADOAs or metamizole.
Journal of Clinical Medicine, 2019
Objectives: To test the hypothesis that allopurinol reduces the risk of acute myocardial infarcti... more Objectives: To test the hypothesis that allopurinol reduces the risk of acute myocardial infarction (AMI) in hyperuricemic patients and to assess whether the effect is dependent on dose, duration and serum uric acid (SUA) level attained after treatment. Methods: Nested case-control study over the period 2002–2015. From a cohort of patients aged 40–99 years old, we identified incident AMI cases and randomly selected five controls per case, matched for exact age, sex and index date. Adjusted odds ratios (AOR) and 95% CI were computed through unconditional logistic regression. Only new users of allopurinol were considered. Results: A total of 4697 AMI cases and 18,919 controls were included. Allopurinol use was associated with a reduced risk of AMI mainly driven by duration of treatment (AOR ≥180 days = 0.71; 95% CI: 0.60–0.84). Among long-term users (≥180 days), the reduced risk was only observed when the SUA level attained was below 7 mg/dL (AOR<6 mg/dL = 0.64; 95% CI: 0.49–0.82; ...
Clinical Pharmacology & Therapeutics, 2019
A population-based case-control study was conducted to evaluate the risk of acute myocardial infa... more A population-based case-control study was conducted to evaluate the risk of acute myocardial infarction among new users of calcium supplements either in monotherapy (CaM) or in combination with vitamin D (CaD). A total of 23,025 cases and 114,851 controls randomly sampled from the underlying cohort and matched with cases by age, sex, and index date were included. New users of CaM and CaD were categorized as current users, recent users, past users, and nonusers. We computed adjusted odds ratios (AORs) and their 95% confidence intervals (CIs) among current users as compared with nonusers through a conditional logistic regression. No increased risk was associated with CaM overall (59 cases (0.26%) and 273 controls (0.24%); AOR = 0.80; 95% CI 0.59-1.09), nor was it found in any of the conditions examined. Instead, the use of CaD was associated with a decreased risk (275 cases (1.19%) and 1,160 controls (1.45%); AOR = 0.78; 95% CI 0.67-0.90), dose and duration-dependent, and particularly evident in patients with a high cardiovascular risk (AOR = 0.59; 95% CI 0.43-0.81). Calcium is an essential micronutrient for bone health and regulation of critical physiological functions. 1 The American National Osteoporosis Foundation 2 recommends for adults a total daily intake of 1,000 mg for women under 51 years old and men under 71 years old, and 1,200 mg for everyone else. Despite calcium being ubiquitous in foods, the recommended daily amounts are often not met making its supplementation a common practice, in particular among women as first-line therapy to prevent osteoporotic fractures, in whom clear benefits have been shown. 2 However, the benefit-risk ratio of this practice has been questioned 3 after
Journal of Clinical Medicine, Aug 14, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Annals of the Rheumatic Diseases, May 30, 2023
Journal of the American Heart Association, Jan 18, 2017
There is controversy surrounding the risk of ischemic stroke associated with the use of calcium s... more There is controversy surrounding the risk of ischemic stroke associated with the use of calcium supplements either in monotherapy or in combination with vitamin D. A nested case-control study was performed with patients aged 40 to 89 years old, among whom a total of 2690 patients had a first episode of nonfatal ischemic stroke and for which 19 538 controls were randomly selected from the source population and frequency-matched with cases for age, sex, and calendar year. Logistic regression provided the odds ratios while adjusting for confounding factors. A sensitivity analysis was performed by restricting to patients who were new users of calcium supplements as either monotherapy or with vitamin D. Calcium supplementation with vitamin D was not associated with an increased risk of ischemic stroke (odds ratio 0.85; 95% confidence interval, 0.67-1.08) in the population as a whole or under any of the conditions examined (dose, duration, background cardiovascular risk, sex, or age). Cal...
Frontiers in Pharmacology
Background: Bisphosphonates have been reported to increase the risk of atrial fibrillation. There... more Background: Bisphosphonates have been reported to increase the risk of atrial fibrillation. Therefore, it is conceivable that they may increase the risk of cardioembolic ischemic stroke (IS). However, most epidemiological studies carried out thus far have not shown an increased risk of IS, though none separated by the main pathophysiologic IS subtype (cardioembolic and non-cardioembolic) which may be crucial. In this study, we tested the hypothesis that the use of oral bisphosphonates increases specifically the risk of cardioembolic IS, and explored the effect of treatment duration, as well as the potential interaction between oral bisphosphonates and calcium supplements and anticoagulants.Methods: We performed a case-control study nested in a cohort of patients aged 40–99 years, using the Spanish primary healthcare database BIFAP, over the period 2002-2015. Incident cases of IS were identified and classified as cardioembolic or non-cardioembolic. Five controls per case were randoml...
Journal of Clinical Medicine, Jan 18, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Revista Española de Quimioterapia, 2021
Introduction. Several factors have been associated with the prognosis of prosthetic joint infecti... more Introduction. Several factors have been associated with the prognosis of prosthetic joint infection (PJI) treated with surgical debridement, antibiotic therapy, and implant retention (DAIR). There is no evidence about the right empirical antibiotic treatment when the causal microorganism is not still identified. Material and methods. We conducted a retrospective observational study in patients with PJI treated with DAIR between 2009 and 2018 in our center. We analyze the risk factors related with their prognosis and the influence of active empirical antibiotic therapy against causative microorganisms in final outcomes. Results. A total of 80 PJI cases treated with DAIR, from 79 patients (58.7% women, mean age 76.3 years), were included in the study period. Among the cases in which empirical antibiotic therapy were active against the causative microorganisms, the success rate was 46/65 (69.2%) vs 1/15 when not (6.7%, OR 31.5, p = 0.001). Factors related to the success or failure of t...
Farmacia hospitalaria : órgano oficial de expresión científica de la Sociedad Española de Farmacia Hospitalaria
Counseling is a technique used in psychology that has shown a major impact on health: in deep, it... more Counseling is a technique used in psychology that has shown a major impact on health: in deep, it is the methodology recommended by the Worl Health Organization to help HIV-infected patients. Although it has been translated to spanish by assisted counseling or helping relationship, counseling covers a broader concept. It is defined as an interactive process based on communication in which the clinician helps the patients to think about their own health and to take appropiate decisions based on their values and interests. In short, counseling is a tool to enhance communication with the patient, resulting very useful during clinical interview in pharmaceutical care programs in order to improve pharmacotherapy and patient safety.
Therapeutic Advances in Musculoskeletal Disease
Background: Several studies have reported that the use of chondroitin sulphate (CS) and glucosami... more Background: Several studies have reported that the use of chondroitin sulphate (CS) and glucosamine may reduce the risk of acute myocardial infarction. Although it is thought that this potential benefit could be extended to ischaemic stroke (IS), the evidence is scarce. Objective: To test the hypothesis that the use of prescription glucosamine or CS reduces the risk of IS. Design: Case–control study nested in an open cohort. Methods: Patients aged 40–99 years registered in a Spanish primary healthcare database (BIFAP) during the 2002–2015 study period. From this cohort, we identified incident cases of IS, applying a case-finding algorithm and specific validation procedures, and randomly sampled five controls per case, individually matched with cases by exact age, gender and index date. Adjusted odds ratios (AORs) and 95% confidence interval (CI) were computed through a conditional logistic regression. Only new users of glucosamine or CS were considered. Results: A total of 13,952 in...
Journal of Clinical Medicine, Mar 10, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Annals of the Rheumatic Diseases, 2021
There is some evidence from epidemiological studies suggesting that CS and glucosamine could play... more There is some evidence from epidemiological studies suggesting that CS and glucosamine could play a role in cardiovascular disease (CVD) prevention (1-4).Studies to date have included prevalent users, therefore a bias that overestimates protection cannot be excluded.To test the hypothesis that chondroitin sulphate (CS) or glucosamine reduce the risk of acute myocardial infarction (AMI).Case-control study nested in a primary cohort composed of patients aged 40 to 99 years, with at least one year of follow-up in the BIFAP database during the 2002-2015 study period. From this cohort of patients, we identified incident cases of AMI and randomly selected five controls per case, matched by exact age, gender, and index date. Adjusted odds ratios (AOR) and their corresponding 95% confidence interval (CI)) were calculated through a conditional logistic regression. Only new users of CS or glucosamine were considered.A total of 23,585 incident cases of AMI and 117,405 controls were included. T...
Heart, 2021
ObjectiveTo assess the relationship between influenza vaccination and risk of a first acute myoca... more ObjectiveTo assess the relationship between influenza vaccination and risk of a first acute myocardial infarction (AMI) in the general population by different epidemic periods.MethodsThis is a population-based case–control study carried out in BIFAP (Base de datos para la investigación farmacoepidemiológica en atención primaria), over 2001–2015, in patients aged 40–99 years. Per each incident AMI case, five controls were randomly selected, individually matched for exact age, sex and index date (AMI diagnosis). A patient was considered vaccinated when he/she had a recorded influenza vaccination at least 14 days before the index date within the same season. The association between influenza vaccination and AMI risk was assessed through a conditional logistic regression, computing adjusted ORs (AOR) and their respective 95% CIs. The analysis was performed overall and by each of the three time epidemic periods per study year (pre-epidemic, epidemic and postepidemic).ResultsWe identified...
Medicina Clínica, 2020
Resumen Antecedentes y objetivo El uso del acido acetilsalicilico a dosis bajas (AAS-DB) en preve... more Resumen Antecedentes y objetivo El uso del acido acetilsalicilico a dosis bajas (AAS-DB) en prevencion primaria es motivo de controversia, pero se desconoce su magnitud en Espana. El objetivo del estudio fue estimar la proporcion de pacientes a los que se prescribio AAS-DB como prevencion primaria durante el periodo 2002-2015 e identificar sus caracteristicas. Metodos En una muestra de la base de datos de atencion primaria para la investigacion farmacoepidemiologica (BIFAP) se obtuvo la proporcion de personas con prescripciones de AAS-DB, excluyendo los pacientes con enfermedad vascular oclusiva, fibrilacion auricular y cancer. Las proporciones se estandarizaron para la poblacion espanola de 40-99 anos. Se construyo un modelo de regresion logistica para identificar los factores asociados a la prescripcion de AAS-DB y se estimo su prevalencia segun la combinacion de dichos factores. Resultados Se incluyeron 102.850 sujetos, 6.198 de ellos usuarios de AAS-DB. La prevalencia estandarizada fue del 2,21% al comienzo del periodo y del 3,57% al final. La prescripcion aumento con la edad. Los factores mas asociados fueron diabetes (OR = 3,26; IC 95%: 3,07-3,47), dislipidemia (OR = 2,08; 1,96-2,21), insuficiencia cardiaca (OR = 2,02; 1,72-2,37) e hipertension (OR = 1,78; 1,67-1,90). La prevalencia de prescripcion de AAS-DB alcanzo el 33,7% en mayores de 70 anos con diabetes, hipertension y dislipidemia. Conclusiones En el periodo estudiado la prescripcion de AAS-DB para prevencion primaria en Espana fue baja en la poblacion general, pero elevada en pacientes diabeticos mayores de 70 anos con factores de riesgo adicionales. Despues de anos de controversia parece necesario adecuar el uso de este farmaco en prevencion primaria a las recomendaciones actuales.
Alimentary Pharmacology & Therapeutics, 2019
Background: Inflammation and overexpression of cyclooxygenase-2 (COX-2) have been described to pl... more Background: Inflammation and overexpression of cyclooxygenase-2 (COX-2) have been described to play a key role in the progression from nonpathologic intestinal mucosa to colorectal cancer (CRC). Aims: To assess the chemoprotective effect of non-aspirin nonsteroidal antiinflammatory drugs (NA-NSAIDs) under different patterns of use in a Mediterranean population and to explore the potential effect of symptomatic slow-acting drugs for osteoarthritis (SYSADOAs; chondroitin sulfate and glucosamine) and metamizole (or dipyrone), also reported to influence COX-2 activity. Methods: We performed a case-control study nested in a cohort extracted from the primary care database, BIFAP. From 2001 to 2014, we included 15 491 incident cases and 60 000 random controls. To estimate the association between the drugs of interest and CRC, we built logistic regression models to compute the adjusted-odds ratios (AOR) and 95% confidence intervals (CI). Results: NA-NSAIDs use was associated with a reduced risk of CRC (AOR = 0.67; 95% CI: 0.63-0.71) and increased linearly with duration of treatment (p for trend <0.001). The effect diminished upon discontinuation but persisted statistically significant up to 1 year. All individual NA-NSAIDs examined showed a decreased risk. The concomitant use of proton-pump inhibitors (PPI) had no impact on the protective effect of NA-NSAIDs; AOR PPI + NSAID = 0.64; 0.58-0.71. SYSADOA use was associated with a reduced risk (0.79; 0.69-0.90) but disappeared after the exclusion of NSAID users during the previous 1 or 3 years (0.85; 0.70-1.04 and 1.00; 0.76-1.31 respectively). Metamizole did not show a chemoprotective effect. Conclusions: NA-NSAID use is associated with a duration-dependent risk reduction of CRC not shared by SYSADOAs or metamizole.
Journal of Clinical Medicine, 2019
Objectives: To test the hypothesis that allopurinol reduces the risk of acute myocardial infarcti... more Objectives: To test the hypothesis that allopurinol reduces the risk of acute myocardial infarction (AMI) in hyperuricemic patients and to assess whether the effect is dependent on dose, duration and serum uric acid (SUA) level attained after treatment. Methods: Nested case-control study over the period 2002–2015. From a cohort of patients aged 40–99 years old, we identified incident AMI cases and randomly selected five controls per case, matched for exact age, sex and index date. Adjusted odds ratios (AOR) and 95% CI were computed through unconditional logistic regression. Only new users of allopurinol were considered. Results: A total of 4697 AMI cases and 18,919 controls were included. Allopurinol use was associated with a reduced risk of AMI mainly driven by duration of treatment (AOR ≥180 days = 0.71; 95% CI: 0.60–0.84). Among long-term users (≥180 days), the reduced risk was only observed when the SUA level attained was below 7 mg/dL (AOR<6 mg/dL = 0.64; 95% CI: 0.49–0.82; ...
Clinical Pharmacology & Therapeutics, 2019
A population-based case-control study was conducted to evaluate the risk of acute myocardial infa... more A population-based case-control study was conducted to evaluate the risk of acute myocardial infarction among new users of calcium supplements either in monotherapy (CaM) or in combination with vitamin D (CaD). A total of 23,025 cases and 114,851 controls randomly sampled from the underlying cohort and matched with cases by age, sex, and index date were included. New users of CaM and CaD were categorized as current users, recent users, past users, and nonusers. We computed adjusted odds ratios (AORs) and their 95% confidence intervals (CIs) among current users as compared with nonusers through a conditional logistic regression. No increased risk was associated with CaM overall (59 cases (0.26%) and 273 controls (0.24%); AOR = 0.80; 95% CI 0.59-1.09), nor was it found in any of the conditions examined. Instead, the use of CaD was associated with a decreased risk (275 cases (1.19%) and 1,160 controls (1.45%); AOR = 0.78; 95% CI 0.67-0.90), dose and duration-dependent, and particularly evident in patients with a high cardiovascular risk (AOR = 0.59; 95% CI 0.43-0.81). Calcium is an essential micronutrient for bone health and regulation of critical physiological functions. 1 The American National Osteoporosis Foundation 2 recommends for adults a total daily intake of 1,000 mg for women under 51 years old and men under 71 years old, and 1,200 mg for everyone else. Despite calcium being ubiquitous in foods, the recommended daily amounts are often not met making its supplementation a common practice, in particular among women as first-line therapy to prevent osteoporotic fractures, in whom clear benefits have been shown. 2 However, the benefit-risk ratio of this practice has been questioned 3 after