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- Lagerros, Ylva Trolle, et al.
(författare)
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Risk of Death in Patients With Coronary Artery Disease Taking Nitrates and Phosphodiesterase-5 Inhibitors
- 2024
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Ingår i: Journal of the American College of Cardiology. - 0735-1097 .- 1558-3597. ; 83:3, s. 417-426
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Phosphodiesterase-5 inhibitor (PDE5i) treatment for erectile dysfunction is associated with lower mortality compared with no treatment for erectile dysfunction after myocardial infarction (MI). There are conflicting results regarding the impact of PDE5i treatment on mortality in conjunction with nitrate medication. OBJECTIVES The purpose of this study was to investigate the association between PDE5i treatment and cardiovascular outcomes in men with stable coronary artery disease treated with nitrate medication. METHODS Using the Swedish Patient Register and the Prescribed Drug Register we included men with previous MI or revascularization in 2006-2013 who had 2 dispensed nitrate prescriptions within 6 months. Exposure was defined as at least 2 filled prescriptions of any PDE5i. We performed multivariable Cox proportional hazard regression to estimate HRs with 95% CIs for all -cause, cardiovascular, and noncardiovascular mortality, MI, heart failure, cardiac revascularization, and major cardiovascular events (MACE). RESULTS In total, 55,777 men were treated with nitrates and 5,710 men with nitrates and a PDE5i. The combined use of PDE5i treatment with nitrates was associated with higher mortality (HR: 1.39; 95% CI: 1.28-1.51), cardiovascular mortality (HR: 1.34; 95% CI: 1.11-1.62), noncardiovascular mortality (HR: 1.40; 95% CI: 1.27-1.54), MI (HR: 1.72; 95% CI: 1.55-1.90), heart failure (HR: 1.67; 95% CI: 1.48-1.90), cardiac revascularization (HR: 1.95; 95% CI: 1.78-2.13), and MACE (HR: 1.70; 95% CI: 1.58-1.83). CONCLUSIONS The use of a PDE5i in combination with nitrate medication in men with stable coronary artery disease may pose an increased hazard for cardiovascular morbidity and mortality. Careful patient -centered consideration before prescribing PDE5is to patients with cardiovascular disease using nitrate medication is warranted. (J Am Coll Cardiol 2024;83:417-426) (c) 2024 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/ 4.0/).
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| 2. |
- Rydén, Jesper, et al.
(författare)
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Estimation of return levels of sea level along the Swedish coast by the method of r largest annual maxima
- 2023
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Ingår i: The proceedings of the International Offshore and Polar Engineering Conference. - 1098-6189.
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Konferensbidrag (refereegranskat)abstract
- Estimation of so-called return values of environmental extremes, of importance in e.g. ocean and coastal engineering, is a challenging problem. Several approaches have been suggested in the literature. In this work, we examine closer a natural extension of the classical approach of block maxima: the r largest annual maxima. We investigate the performance on measurements of sea level at three locations along the Swedish coastline, and pay attention to the practical implications of the assumptions of the method. Return levels are estimated for various return periods along with related confidence intervals and compared with the conventional block-maxima approach. We find that the upper bound of the confidence intervals is considerably reduced compared to the traditional methodology, in particular for higher return periods.
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