Tag: angina

Categories : Cardiovascular DiseaseTags :

Researchers Urge Caution in Co-prescribing Potency Drugs and Nitrates

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Co-prescribing potency drugs such as Viagra and organic nitrates for angina is associated with a 35–40% increased mortality risk and about 70% higher risk of heart attack and heart failure. This is according to a Swedish registry study published in the Journal of the American College of Cardiology. The Swedish researchers are now urging caution.

Drugs for erectile dysfunction or impotence containing phosphodiesterase inhibitors type 5 are contraindicated in the treatment of angina with organic nitrates. Because the two types of drugs enhance each other’s antihypertensive effect, they can cause serious side effects, including death, if taken together.

But many people who treat angina with organic nitrates use the medication as emergency relief for a sudden onset of angina. The medication is quickly absorbed by the body, exerts its effect, and then breaks down quickly again. It is not usually a permanent treatment, although maintenance treatment is possible. 

Does not necessarily indicate an increased risk

Potency drugs are also taken as needed, which theoretically makes it possible to separate the two treatments in time to avoid side effects. If patients are aware of these factors, co-prescribing does not necessarily mean an increased risk.

Previous studies have shown that an increasing number of men who treat their angina with organic nitrates are also prescribed potency drugs. However, there is no evidence that side effects have increased. 

The picture is not entirely clear, as it has also been shown that type 5 phosphodiesterase inhibitors for men with cardiovascular disease without angina reduce the risk of death and heart failure.

“There is an increasing demand for medication for erectile dysfunction from men with cardiovascular disease. And even if these drugs are beneficial for most men with cardiovascular disease, those who are also treated with nitrates need to consider the benefits of the drug against the cardiovascular risks,” says first author Ylva Trolle Lagerros, Associate Professor at the Department of Medicine at Karolinska Institutet.

To find out what the actual risk of concurrent prescribing is, the researchers used Swedish health registers between 2005 and 2013. They found nearly 61 500 men who had been prescribed organic nitrates, of which just over 5700 had also been prescribed one of the potency drugs in question. A clear majority of those who had a prescription for both medications used nitrates as an emergency treatment only.

Adjusted for differences

The men who received the drugs were on average nine years younger and significantly healthier than those who did not receive them. The researchers therefore had to adjust for these and other differences.

The adjusted results show that co-prescribing potency drugs with type 5 phosphodiesterase inhibitors and organic nitrates is associated with a 35–40% increased risk of death. In addition, the researchers show an approximately 70% increased risk of heart attack and heart failure. This suggests that the theoretical separation in time of the treatments does not seem to work fully.

“We want to point out the importance of careful and patient-centered consideration before prescribing this type of potency medication to men treated with nitrates,” says Ylva Trolle Lagerros.

Source: Karolinska Institutet

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Recurrence Risk of Heart Attack is Increased by Long Hours

On By ModernMedia
Photo of neon-lit heart by Leon Collett, via Unsplash.

For heart attack survivors, the risk of recurrent coronary heart disease is increased by working long hours.

Heart attack survivors who working 55+ hours per week were at higher risk of recurrent coronary heart disease (CHD) events (ie, myocardial infarction [MI] or unstable angina) over 6 years compared with people working a more standard 35-40 hours a week (adjusted HR 1.67). This included adjustment for sociodemographics, lifestyle-related risk factors, clinical risk factors, work environment factors, and personality factors.

“These results showed a linear risk increase after 40 h/week and a stronger effect after the first 4 years of follow-up and when long working hours are combined with job strain,” wrote Xavier Trudel, PhD, of CHU de Québec-Laval University Research Centre in Quebec City, and colleagues. 
The researchers suggested secondary interventions in curbing working hours among patients at risk of CHD recurrence.

In an accompanying editorial, Jian Li, MD, PhD, of UCLA, and Johannes Siegrist, PhD, of Heinrich-Heine-University, concurred: A “short standardized assessment of working time and stressful working conditions among economically active cardiac patients would enrich physicians’ awareness of patients’ needs and inform medical decision making.”

“With the transformation of the modern work due to technological advances and economic globalisation, an increase in work load and an extension of irregular, nonstandard forms of employment, including working from home, were reported, aggravating the control and prevention of long working hours,” Drs Li and Siegrist wrote.

They urged cardiac rehabilitation programmes to offer “training skills of coping with stressful demands and of strengthening resilience and relaxation” and involving occupational health services to develop return-to-work plans.

When cardiac disease patients return to work, their workplaces will need to adopt tailored, programs to retain the workers and manage disease, Drs Li and Siegrist added.

The prospective cohort study included 967 MI survivors under age 60, of whom 205 had a recurrent CHD event over follow-up averaging 5.9 years.Men and people in their 40s and 50s were most likely to be working long hours after an MI. Job strain, defined as a combination of high psychological demands and low decision latitude at work, was measured with a questionnaire.

Work hours for each participant were assessed only once, at about 6 weeks after returning to work. “Some patients could have changed exposure during follow-up, leading to potential nondifferential misclassification and to an underestimation of the true effect,” Trudel’s group acknowledged.

The observational study was limited by only one tenth of participants being women, limiting generalisability, and by unknown confounding variables.

“In conclusion, the study by Trudel et al. provides a new piece of research evidence that work-related factors play an important role in CHD prognosis,” Drs Li and Siegrist wrote. “Occupational health services are urgently needed to be incorporated into cardiac rehabilitation programs and secondary prevention of CHD.”

Source: MedPage Today

Journal article information: Trudel X, et al “Long working hours and risk of recurrent coronary events” J Am Coll Cardiol 2021; DOI: 10.1016/j.jacc.2021.02.012.

Editorial information: Li J, Siegrist J “Occupational risks of recurrent coronary heart disease” J Am Coll Cardiol 2021; DOI: 10.1016/j.jacc.2021.02.020.