Jun Takahashi1, Taro Nihei1, Yusuke Takagi1, Satoshi Miyata1, Yuji Odaka1, Ryusuke Tsunoda2, Atsushi Seki3, Tetsuya Sumiyoshi3, Motoyuki Matsui4, Toshikazu Goto4, Yasuhiko Tanabe5, Shozo Sueda6, Shin-ichi Momomura7, Satoshi Yasuda8, Hisao Ogawa9, Hiroaki Shimokawa10. 1. Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan. 2. Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan. 3. Sakakibara Heart Institute, Tokyo, Japan. 4. Yamagata Prefectural Central Hospital, Yamagata, Japan. 5. Niigata Prefectural Shibata Hospital, Shibata, Japan. 6. Ehime Prefectural Niihama Hospital, Niihama, Japan. 7. Jichi Medical University Saitama Medical Center, Saitama, Japan. 8. National Cerebral and Cardiovascular Center, Suita, Japan. 9. Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan. 10. Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan shimo@cardio.med.tohoku.ac.jp.
Abstract
AIMS: Although nitrates are widely used as a concomitant therapy with calcium channel blockers (CCBs) for vasospastic angina (VSA), their prognostic contribution remains unclear. The present study aimed to examine the prognostic impact of chronic nitrate therapy in patients with VSA. METHODS AND RESULTS: A total of 1429 VSA patients (median 66 years; male/female, 1090/339) were enrolled. The primary endpoint was defined as major adverse cardiac events (MACE). The propensity score matching and multivariable Cox proportional hazard model were used to adjust for selection bias for treatment and potential confounding factors. Among the study patients, 695 (49%) were treated with nitrates, including conventional nitrates [e.g. nitroglycerin (GTN), isosorbide mono- and dinitrate] in 551 and nicorandil in 306. Calcium channel blockers were used in >90% of patients. During the median follow-up period of 32 months, 85 patients (5.9%) reached the primary endpoint. Propensity score-matched analysis demonstrated that the cumulative incidence of MACE was comparable between the patients with and those without nitrates [11 vs. 8% at 5 years; hazard ratio (HR): 1.28; 95% confidence interval (CI): 0.72-2.28, P = 0.40]. Although nicorandil itself had a neutral prognostic effect on VSA (HR: 0.80; 95% CI: 0.28-2.27, P = 0.67), multivariable Cox model revealed the potential harm of concomitant use of conventional nitrates and nicorandil (HR: 2.14; 95% CI: 1.02-4.47; P = 0.044), particularly when GTN and nicorandil were simultaneously administered. CONCLUSIONS: Chronic nitrate therapy did not improve the long-term prognosis of VSA patients when combined with CCBs. Furthermore, the VSA patients with multiple nitrates would have increased risk for cardiac events. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Although nitrates are widely used as a concomitant therapy with calcium channel blockers (CCBs) for vasospastic angina (VSA), their prognostic contribution remains unclear. The present study aimed to examine the prognostic impact of chronic nitrate therapy in patients with VSA. METHODS AND RESULTS: A total of 1429 VSA patients (median 66 years; male/female, 1090/339) were enrolled. The primary endpoint was defined as major adverse cardiac events (MACE). The propensity score matching and multivariable Cox proportional hazard model were used to adjust for selection bias for treatment and potential confounding factors. Among the study patients, 695 (49%) were treated with nitrates, including conventional nitrates [e.g. nitroglycerin (GTN), isosorbide mono- and dinitrate] in 551 and nicorandil in 306. Calcium channel blockers were used in >90% of patients. During the median follow-up period of 32 months, 85 patients (5.9%) reached the primary endpoint. Propensity score-matched analysis demonstrated that the cumulative incidence of MACE was comparable between the patients with and those without nitrates [11 vs. 8% at 5 years; hazard ratio (HR): 1.28; 95% confidence interval (CI): 0.72-2.28, P = 0.40]. Although nicorandil itself had a neutral prognostic effect on VSA (HR: 0.80; 95% CI: 0.28-2.27, P = 0.67), multivariable Cox model revealed the potential harm of concomitant use of conventional nitrates and nicorandil (HR: 2.14; 95% CI: 1.02-4.47; P = 0.044), particularly when GTN and nicorandil were simultaneously administered. CONCLUSIONS: Chronic nitrate therapy did not improve the long-term prognosis of VSA patients when combined with CCBs. Furthermore, the VSA patients with multiple nitrates would have increased risk for cardiac events. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Evan Paul Tracy; William Hughes; Jason E Beare; Gabrielle Rowe; Andreas Beyer; Amanda Jo LeBlanc Journal: Antioxid Redox Signal Date: 2021-09-17 Impact factor: 7.468
Authors: Taeshik Park; Ji Young Park; Seung Woon Rha; Hong Seog Seo; Byoung Geol Choi; Se Yeon Choi; Jae Kyeong Byun; Sang Ho Park; Eun Jin Park; Jah Yeon Choi; Sung Hun Park; Jae Joong Lee; Sunki Lee; Jin Oh Na; Cheol Ung Choi; Hong Euy Lim; Jin Won Kim; Eung Ju Kim; Chang Gyu Park; Dong Joo Oh Journal: Yonsei Med J Date: 2017-01 Impact factor: 2.759