B-vitamin Treatment Modifies the Mortality Risk Associated with Calcium Channel Blockers in Patients with Suspected Stable Angina Pectoris: A Prospective Cohort Study.
| Autor: | Dhar I; Department of Clinical Science, Mohn Nutrition Research Laboratory, University of Bergen, Bergen, Norway; Department of Clinical Medicine, Centre for Nutrition, University of Bergen, Norway. Electronic address: Indu.Dhar@uib.no., Svingen GF; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway., Bjørnestad EØ; Department of Cardiology, Stavanger University Hospital, Stavanger, Norway., Ulvik A; Bevital AS, Bergen, Norway., Saeed S; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway., Nygård OK; Department of Clinical Science, Mohn Nutrition Research Laboratory, University of Bergen, Bergen, Norway; Department of Clinical Medicine, Centre for Nutrition, University of Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. |
|---|---|
| Jazyk: | angličtina |
| Zdroj: | The American journal of clinical nutrition [Am J Clin Nutr] 2023 Jul; Vol. 118 (1), pp. 77-84. Date of Electronic Publication: 2023 Apr 28. |
| DOI: | 10.1016/j.ajcnut.2023.04.033 |
| Abstrakt: | Background: Calcium channel blockers (CCBs) are used for the treatment of cardiovascular disease (CVD), including angina pectoris, and hypertension; however, the effect on survival remains uncertain. CCBs impair fibrinolysis and have been linked to elevated plasma homocysteine (Hcy), a CVD risk marker. Objective: We explored the association between CCB use and mortality in a large prospective cohort of patients with suspected stable angina pectoris (SAP), and potential effect modifications by Hcy-lowering B-vitamin treatment (folic acid, B Methods: Patient baseline continuous characteristics according to CCB treatment were tested by linear regression. Hazard ratios (HRs) for mortality associated with CCB treatment, also according to B-vitamin intervention, were examined using Cox regression analysis. The multivariable model included CVD risk factors, medical histories, and the use of CVD medications. Results: A total of 3991 patients (71.5 % men) were included, of whom 907 were prescribed CCBs at discharge. During 10.3 years of median follow-up, 20.6% died and 8.9% from cardiovascular- and 11.7% from non-cardiovascular causes. Patients treated with CCBs had higher plasma Hcy, fibrinogen levels, and erythrocyte sedimentation rate (all P<0.001). Furthermore, CCB use was positively associated with mortality, also after multivariable adjustments (HRs [95% CIs]: 1.34 [1.15,1.57], 1.35 [1.08,1.70], and 1.33 [1.09,1.64] for total, CVD, and non-CVD death, respectively). Numerically stronger associations were observed among patients not treated with B-vitamins (HR [95% CI]: 1.54 [1.25, 1.88], 1.69 [1.25, 2.30], and 1.41 [1.06, 1.86] for total, CVD deaths, and non-CVD deaths, respectively), whereas no association was seen in patients treated with B-vitamins (HR [95% CI]: 1.15 [0.91, 1.46], 1.09 [0.76, 1.57], and 1.20 [0.88, 1.65]). Conclusions: In patients with suspected SAP, CCB treatment was associated with increased mortality risk primarily among patients not treated with B-vitamins. (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.) |
| Databáze: | MEDLINE |
| Externí odkaz: |
|