Bleeding Complications With Dual Antiplatelet Therapy Among Patients With Stable Vascular Disease or Risk Factors for Vascular Disease: Results From the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA) Trial

Abstract

Conclusion:High-density lipoprotein is the most important lipid in predicting the risk of development of an abdominal aortic aneurysm (AAA).Summary: The relationship between dyslipidemia and development of AAA is unclear. Some studies have reported an association between lowdensity lipoprotein (LDL) or high-density lipoprotein (HDL) and AAA; others have found no association. Previous studies have not used consistent definitions of dyslipidemia, have not stratified the current use of lipid modifying medications, and often have not adjusted for other determinants of AAA. The result has been confusion regarding the role of dyslipidemia in the development of AAA.The current study was designed to examine the association of serum concentration of lipids and AAA in a population screening study. Data were adjusted for known clinical determinants of AAA and use of lipid-modifying medications. The study analyzed 3327 men aged 65 to 83 years. Analysis was adjusted for established risk factors of AAA and the presence of prescriptions of lipid-modifying agents. At the time of fasting lipid measurement, 1043 men (31%) were receiving lipid-modifying therapy; statins in Ͼ98% of the cases. Serum HDL concentrations were lower in patients with AAA. HDL concentration was independently associated with a decreased risk of an AAA in men not receiving lipid-modifying therapy (odds ratio, 0.72; 95% confidence interval, 0.56-0.93 per 0.4-mM increase) as well as in the total cohort (odds ratio, 0.76; 95% confidence interval, 0.63-0.91 per 0.4-mM increase, adjusted for lipid-modifying therapy). Levels of triglycerides and LDL were not associated with the presence of AAA.Comment: The authors have demonstrated a consistent association between a low serum HDL concentration and the presence of AAA in a population prone to aortic dilatation. The fact that the association was present in subgroups not receiving lipid-modifying medications and in men after adjusting for other risk factors, including lipid-modifying medications, is evidence modification of HDL levels may be a therapeutic target in the prevention of AAA. Atheroembolic Disease-A Frequently Missed Diagnosis: Results of a 12-Year Matched-Pair Autopsy Study Fries C, Roos M, Gaspert A, et al. Medicine 2010;89:126-32.

Clopidogrel and PPI Interaction: Clinically Relevant or Not?

“…In the CURE trial, GI bleeding occurred in 1.3% of patients over a 3-to 12-month period [5]. Berger et al [21] recently reported the bleeding complications associated with dual antiplatelet therapy in the CHARISMA trial, which compared aspirin with dual antiplatelet therapy in patients with stable vascular disease or risk factors for vascular disease. In this trial, the addition of clopidogrel led to a 48% relative increase in the risk of moderate or severe bleeding.…”

“…Fifty-three percent of these bleeding events were GI-related, with an overall rate of 1.7% at 28 months. After multivariate analysis, GI bleeding was associated with allcause mortality with an adjusted hazard ratio (HR) of 1.82 (95% CI, 1.24-2.69) [21].…”

Risk Stratification in Elderly Coronary Artery Disease Patients: Can We Predict Which Seniors Benefit Most from Revascularization Options?

“…Clopidogrel use was associated with a more than doubled bleeding risk in patients older than 75 years [48]. Also the use of glycoprotein IIb/IIIa inhibitors was linked with bleeding risk in octogenarians [49].…”

The Year in Epidemiology, Health Services Research, and Outcomes Research

“…In a 28-month trial of clopidogrel, 3.1% of the 15,603 patients had severe or moderate bleeding complications, most commonly gastrointestinal bleeding. Bleeding was increased by older age, heart failure, diabetes, and the use of clopidogrel (55). The occurrence of either bleeding, MI, or stroke each increased the risk for death during follow-up by more than 2-fold (55).…”