RESEARCH ARTICLE SA JOURNAL OF DIABETES & VASCULAR DISEASE 28 VOLUME 20 NUMBER 2 • NOVEMBER 2023 References 1. Yamamuro M, Lytle BW, Sapp SK, et al. Risk factors and outcomes after coronary reoperation in 739 elderly patients. Ann Thorac Surg 2000; 69(2): 464–474. 2. Cooley DA. In memoriam. Tribute to René Favaloro, pioneer of coronary bypass. Texas Heart Inst J 2000; 27(3): 231–232. 3. Shapira OM, Hunter CT, Anter E, et al. Coronary artery bypass grafting in patients with severe left ventricular dysfunction – early and midterm outcomes. J Cardiac Sur 2006; 21(3): 225–232. 4. David G, Mario G, Juan G. The evolution of coronary bypass surgery will determine its relevance as the standard of care for the treatment for multivessel coronary artery disease. Circulation 2016; 134(17): 1206–1208. 5. Hashimoto K, Miyamoto H, Suzuki K, et al. Evidence of organ damage after cardiopulmonary bypass. The role of elastase and vasoactive mediators. J Thora Cardiovasc Surg 1992; 104(3): 666–673. 6. Zanardo G, Michielon P, Paccagnella A, et al. Acute renal failure in the patient undergoing cardiac operation. Prevalence, mortality rate, and main risk factors. J Thorac Cardiovasc Surg 1994; 107(6): 1489–1495. 7. Rahimi Z, Mansouri Zaveleh O, Rahimi Z, et al. AT2R – 1332 G: A polymorphism and diabetic nephropathy in type 2 diabetes mellitus patients. J Renal Injury Prevent 2013; 2(3): 97–101. 8. Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2(1): 1–138. 9. Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care (London) 2007; 11(2): R31. 10. Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabetic Med 1997; 14(Suppl 5): S1–S85. 11. Ali MK, Narayan KM, Tandon N. Diabetes and coronary heart disease: current perspectives. Indian J Med Res 2010; 132(5): 584–597. 12. Stallwood MI, Grayson AD, Mills K, et al. Acute renal failure in coronary artery bypass surgery: Independent effect of cardiopulmonary bypass. Ann Thorac Surg 2004; 77: 968–972. 13. Sousa-Uva M, Neumann FJ, Ahlsson A, et al. ESC Scientific Document Group. Eur J Cardiothorac Surg 2019; 55(1): 4–90. 14. Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment. Nat Rev Nephrol 2017; 13: 697–711. 15. Hertzberg D, Sartipy U, Lund LH, et al. Heart failure and the risk of acute kidney injury in relation to ejection fraction in patients undergoing coronary artery bypass grafting. Int J Cardiol 2019; 274: 66–70. 16. McFalls EO, Ward HB, Moritz TE, et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med 2004; 351: 2795–2804. 17. Bastin AJ, Ostermann M, Slack AJ, et al. Acute kidney injury after cardiac surgery according to Risk/Injury/Failure/Loss/End-stage, Acute Kidney Injury Network and Kidney Disease: Improving Global Outcomes classifications. J Crit Care 2013; 28(4): 389–396. 18. Sampaio MC, Máximo CAG, Montenegro CM, et al. Comparison of diagnostic criteria for acute kidney injury in cardiac surgery. Arq Bras Cardiol 2013; 18–25. 19. Szabó Z, Håkanson E, Svedjeholm R. Early postoperative outcome and mediumterm survival in 540 diabetic and 2239 nondiabetic patients undergoing coronary artery bypass grafting. Ann Thorac Surg 2002; 74: 712–719. 20. Third Report of National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, Abd Treatment of High Blood Cholesterol in Adults (Adults Treatment Panel IU) Final Report. Circulation 2002; 106: 314–334. 21. Yusuf V, Mehmet I. Early-term outcomes of off-pump versus on-pump beating-heart coronary artery bypass surgery. Thorac Cardiovasc Surg 2019; 67(07): 546–553. 22. Wagener G, Jan M, Kim M, et al. Association between increases in urinary neutrophil gelatinase-associated lipocalin and acute renal dysfunction after adult cardiac surgery. Anesthesiology 2006; 105: 485–491. Several position statements already caution against both short- and long-term use of NSAIDs in patients at high cardiovascular risk, with the suggestion that use be of the shortest duration at the lowest dose that provides relief, the editorialists noted. Escalating that to a guideline recommendation would be ‘premature’, based on a single observational study, Khan and Kunutsor wrote. ‘Further robust clinical trial evidence is needed to replicate these results and investigate the relationship of the type and dose of NSAIDs with heart failure risk. However, it should be realised that short- or long-term use of NSAIDs may be detrimental to cardiovascular health.’ NSAIDs have potential cardiotoxic effects on fluid retention and blood pressure, but in this study, the five-year mortality risk after first-time heart failure hospitalisation was comparable for both NSAID-exposed and non-exposed patients, ‘suggesting that heart failure associated with the use of NSAIDs could be more than temporary fluid overload’, Holt and team wrote. Subgroup analysis turned up increased risk with poorly managed HbA1c levels but not among patients with normal HbA1c levels, independent of antidiabetic treatment intensity, which the researchers said ‘suggests that the combined effects of hyperglycaemia and NSAID exposure may lead to endothelial dysfunction, resulting in heart failure’, or ‘demasking’ subclinical heart failure caused by T2D. ‘However, the trend for stronger associations in subgroups with suspected compromised kidney function implies that both mechanisms (fluid overload and endothelial dysfunction) probably play important roles,’ they added. How they did it The study used nationwide Danish registers to identify all 331 189 adults (mean age 62 years, 44.2% women) diagnosed with T2D or started on antidiabetic medication from 1998 to 2021, who had no previous heart failure, rheumatic disease, or filled NSAID prescriptions 120 days before diagnosis. Type 1 diabetes patients and women under age 40 years who were only taking metformin (who might represent polycystic ovary syndrome rather than T2D) were excluded. While the primary associations examined were between NSAIDs and first-time heart failure hospitalisation using a case-crossover design with 28-day exposure windows, results were similar with 14- and 42-day windows. The study classified exposure as filled prescriptions for celecoxib, diclofenac, ibuprofen or naproxen – the main NSAIDs used in Denmark. Associations were similar for diclofenac and ibuprofen, but the results were insignificant for celecoxib and naproxen, possibly due to too few prescriptions filled. Of the 16% of patients who filled at least one NSAID prescription, ibuprofen was most common (12.2%), followed by diclofenac (3.3%), while naproxen and celecoxib prescriptions were each filled by less than 1% of patients. The few events that occurred after celecoxib and naproxen prescription limited the study’s ability to reliably explore for a class effect, the editorialists pointed out. ‘This is clinically relevant given that the various NSAIDs reversibly inhibit the enzyme cyclooxygenase (COX) in both of its isoforms, COX-1 and COX-2; however, their COX selectivity and associated cardiovascular risk vary,’ Khan and Kunutsor noted. ‘Evidence suggests that naproxen, a non-selective NSAID, is associated with the lowest risk of cardiovascular events, whereas diclofenac is associated with the highest cardiovascular risk among non-selective NSAIDs.’ Other limitations included the potential for time-varying and residual confounding and selection bias, as well as the fact that the researchers were only able to capture the short-term effects of transient exposures. In addition, the observational study could not establish a causal relationship. Source: MedicalBrief 2023 Continued from page 23
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