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Risk of atrial fibrillation with use of oral and intravenous bisphosphonates.
Am J Cardiol. 2014 Jun 01; 113(11):1815-21.AJ

Abstract

Clinical studies suggest an association between bisphosphonate use and new-onset atrial fibrillation (AF). Intravenous bisphosphonates more potently increase the release of inflammatory cytokines than do oral bisphosphonates; thus, the risk of developing AF may be greater with intravenous preparations. We have evaluated incidence of new-onset AF with use of oral and intravenous bisphosphonates through a systematic review and meta-analysis of the literature. We searched PubMed, CINAHL, Cochrane Central Register of Controlled Trials, Scopus, and EMBASE databases for observational studies and randomized controlled trials (RCTs) published from 1966 to April 2013 that reported the number of patients developing AF with use of oral or intravenous bisphosphonates. The random-effects Mantel-Haenszel test was used to evaluate the relative risk of AF with use of oral and intravenous bisphosphonates. Nine studies (5 RCTs and 4 observational studies) were included in the final analysis. Pooled data from RCTs and observational studies (n = 135,347) showed a statistically significantly increased risk of new-onset AF with both intravenous (relative risk 1.40, 95% confidence interval 1.32 to 1.49) and oral (relative risk 1.22, 95% confidence interval 1.14 to 1.31) bisphosphonates. The z statistic, which assesses the difference between the 2 risk ratios, indicated higher risk of AF with intravenous bisphosphonates versus oral bisphosphonates (p = 0.03). In conclusion, pooled data from RCTs and observational studies suggest that risk of AF is increased by use of oral or intravenous bisphosphonates but further suggest that risk is relatively greater with intravenous preparations.

Authors+Show Affiliations

Department of Medicine, Maimonides Medical Center, Brooklyn, New York. Electronic address: abhisheksharma4mamc@gmail.com.Division of Cardiology, Department of Medicine, Columbia University Medical Center and NewYork-Presbyterian Hospital, New York, New York; Department of Radiology, Columbia University Medical Center and NewYork-Presbyterian Hospital, New York, New York.Division of Cardiology, University of Kansas Medical Center, Kansas City, Kansas.Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, New York.Division of Cardiology, Texas Tech University, El Paso, Texas.Division of Statistics, Maimonides Medical Center, Brooklyn, New York.Division of Cardiovascular Medicine and The Howard Gilman Institute for Heart Valve Disease, State University of New York Downstate Medical Center, Brooklyn, New York.Department of Medicine, Maimonides Medical Center, Brooklyn, New York.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

24837258

Citation

Sharma, Abhishek, et al. "Risk of Atrial Fibrillation With Use of Oral and Intravenous Bisphosphonates." The American Journal of Cardiology, vol. 113, no. 11, 2014, pp. 1815-21.
Sharma A, Einstein AJ, Vallakati A, et al. Risk of atrial fibrillation with use of oral and intravenous bisphosphonates. Am J Cardiol. 2014;113(11):1815-21.
Sharma, A., Einstein, A. J., Vallakati, A., Arbab-Zadeh, A., Walker, M. D., Mukherjee, D., Homel, P., Borer, J. S., & Lichstein, E. (2014). Risk of atrial fibrillation with use of oral and intravenous bisphosphonates. The American Journal of Cardiology, 113(11), 1815-21. https://doi.org/10.1016/j.amjcard.2014.03.008
Sharma A, et al. Risk of Atrial Fibrillation With Use of Oral and Intravenous Bisphosphonates. Am J Cardiol. 2014 Jun 1;113(11):1815-21. PubMed PMID: 24837258.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of atrial fibrillation with use of oral and intravenous bisphosphonates. AU - Sharma,Abhishek, AU - Einstein,Andrew J, AU - Vallakati,Ajay, AU - Arbab-Zadeh,Armin, AU - Walker,Marcella Donovan, AU - Mukherjee,Debabrata, AU - Homel,Peter, AU - Borer,Jeffrey S, AU - Lichstein,Edgar, Y1 - 2014/03/15/ PY - 2014/01/30/received PY - 2014/03/06/revised PY - 2014/03/06/accepted PY - 2014/5/20/entrez PY - 2014/5/20/pubmed PY - 2014/7/9/medline SP - 1815 EP - 21 JF - The American journal of cardiology JO - Am J Cardiol VL - 113 IS - 11 N2 - Clinical studies suggest an association between bisphosphonate use and new-onset atrial fibrillation (AF). Intravenous bisphosphonates more potently increase the release of inflammatory cytokines than do oral bisphosphonates; thus, the risk of developing AF may be greater with intravenous preparations. We have evaluated incidence of new-onset AF with use of oral and intravenous bisphosphonates through a systematic review and meta-analysis of the literature. We searched PubMed, CINAHL, Cochrane Central Register of Controlled Trials, Scopus, and EMBASE databases for observational studies and randomized controlled trials (RCTs) published from 1966 to April 2013 that reported the number of patients developing AF with use of oral or intravenous bisphosphonates. The random-effects Mantel-Haenszel test was used to evaluate the relative risk of AF with use of oral and intravenous bisphosphonates. Nine studies (5 RCTs and 4 observational studies) were included in the final analysis. Pooled data from RCTs and observational studies (n = 135,347) showed a statistically significantly increased risk of new-onset AF with both intravenous (relative risk 1.40, 95% confidence interval 1.32 to 1.49) and oral (relative risk 1.22, 95% confidence interval 1.14 to 1.31) bisphosphonates. The z statistic, which assesses the difference between the 2 risk ratios, indicated higher risk of AF with intravenous bisphosphonates versus oral bisphosphonates (p = 0.03). In conclusion, pooled data from RCTs and observational studies suggest that risk of AF is increased by use of oral or intravenous bisphosphonates but further suggest that risk is relatively greater with intravenous preparations. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/24837258/Risk_of_atrial_fibrillation_with_use_of_oral_and_intravenous_bisphosphonates_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(14)00797-8 DB - PRIME DP - Unbound Medicine ER -