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Risk factors for acute myocardial infarction in patients with alcohol-related cirrhosis - a Danish nested
Emma Celia Herting1,2, Rasmine Birn-Rydder1,2, Konstantin Kazankov1,2
1Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Patients with alcohol-related cirrhosis (ALD cirrhosis) face increased risks for myocardial infarction (MI) due to factors like infection and heart failure. Anticoagulants may offer protection against MI in this population.
Area of Science:
- Cardiology
- Hepatology
- Public Health
Background:
- Alcohol-related cirrhosis (ALD cirrhosis) presents a complex relationship with arterial and venous thrombotic events.
- The specific risk factors for acute myocardial infarction (MI) in patients with ALD cirrhosis remain incompletely understood.
Purpose of the Study:
- To identify and analyze the key risk factors associated with acute myocardial infarction (MI) among patients diagnosed with alcohol-related cirrhosis (ALD cirrhosis).
Main Methods:
- A nationwide, register-based, nested case-control study was conducted using Danish patient data from 2000-2019.
- Cases were patients with a first-time MI post-ALD cirrhosis diagnosis; controls (10:1 ratio) were matched cohort members without MI history.
- Conditional logistic regression analyzed associations between pre-selected risk factors and MI odds.
Main Results:
- Key MI risk factors identified in ALD cirrhosis patients include hospitalization for infection, recent surgery, and pre-existing atherosclerosis.
- Comorbidities such as cardiac ischemia, heart failure, and chronic obstructive pulmonary disease (COPD) significantly elevated MI risk.
- Anticoagulant use demonstrated a protective effect against MI in this cohort.
Conclusions:
- This study elucidates significant risk factors for MI in patients with ALD cirrhosis, including infections, surgery, and cardiovascular comorbidities.
- Findings highlight the potential clinical utility of risk factor assessment and thromboprophylaxis in managing MI risk in ALD cirrhosis patients.
Background & Aims:
Alcohol-related cirrhosis (ALD cirrhosis) has a weaker effect on acute myocardial infarction (MI) than on other arterial or venous thromboses, and the reasons for this pattern are unclear. This study aimed to identify risk factors of MI amongst patients with ALD cirrhosis.
Methods:
This nationwide register-based nested case-control study was conducted within a cohort of all Danish patients diagnosed with ALD cirrhosis from 2000-2019. Patients with first-time MI after diagnosis of ALD cirrhosis were identified as cases, and matching cohort members (10:1) with no history of MI, using risk-set sampling. We selected candidate risk factors a priori and used conditional logistic regression to study the association between them and the adjusted odds ratio of MI.
Results And Conclusions:
We included 373 cases and 3,730 controls. We identified the following risk factors for MI: hospitalization for infection (adjusted odds ratio 2.26 [95% CI 1.38-3.71]), recent surgery (adjusted odds ratio 1.82 [95% CI 1.18-2.81]), history of atherosclerosis (adjusted odds ratio 1.89 [95% CI 1.39-2.57]), cardiac ischemia (adjusted odds ratio 6.23 [95% CI 4.30-9.04]), heart failure (adjusted odds ratio 2.83 [95% CI 1.90-4.22]) or chronic obstructive pulmonary disease (COPD) (adjusted odds ratio 2.26 [95% CI 1.62-3.17]). Use of anticoagulants had a protective effect (adjusted odds ratio 0.47 [95% CI 0.25-0.91]). Our findings contribute to the understanding of risk factors for MI in patients with ALD cirrhosis. They may have clinical implications e.g. for the decision to offer thromboprophylaxis.
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