SAT0446 RISK OF ACUTE MYOCARDIAL INFARCTION (AMI) AMONG NEW USERS OF BISPHOSPHONATES: A NESTED CASE-CONTROL STUDY
Authors: R. Mazzucchelli, S. Rodriguez-Martin, A. García-Vadillo, A. García-Lledó, M. Gil, F. De Abajo
Journal: Annals of the Rheumatic Diseases (2020)

Background: Evidence suggest that bisphosphonates (BF) may inhibit atherosclerosis and vascular calcification. In several small-scale clinical trials, BF improved some intermediate targets of atherosclerosis. Observational studies found a lower risk of Acute Myocardial Infarction (AMI) or stroke among BF users compared to non-users. While this epidemiological evidence suggests that BF may protect against cardiovascular events a “prevalent user bias” cannot be excluded. Objectives: To analyze the hypothesis that BF reduce de risk of AMI in new users and assess whether the effect depends on the duration of treatment. Methods: Case-control study nested in a primary cohort composed of patients aged 40 to 99 years, with at least one year of follow-up in the BIFAP database during the 2002-2015 study period. From this cohort of patients, we identified incident cases of AMI and randomly selected five controls per case, matched by exact age, gender, and index date. Adjusted odds ratios (AOR) and their corresponding 95% confidence interval (CI) were calculated through an unconditional logistic regression. Only new users of BF were considered. Results: A total of 23,590 cases of IAM and 117,612 controls were included. The mean age was 66.8 (SD 13.4) years and 72.52% were male, in both groups. 584 (2,47%) cases and 2,892 (2.46%) controls used or had used some bisphosphonate. The use of BF was not associated with a lower risk of IAM ( AOR 0.97; 95%CI: 0.84–1.13 ). Nor was it associated with the duration of treatment ( AOR less than 1 year = 0.91; 95%CI: 0.72-1.15 ); AOR more than 1 year= 1.01; 95%CI: 0.84-1.21 ). The stratified analysis by age and sex also did not show either a protective effect of BF. Detailed results by BF type are shown in the following table: Cases (% ) Controls (% ) Non-adjusted OR Adjusted OR N=23590 N=117612 (95% CI ) (95% CI ) Bisphosphonates Non users 23006 (97.52) 114720 (97.54) 1 (Ref.) 1 (Ref.) Current 276 (1.17) 1458 (1.24) 0.93 (0.81-1.06) 0.97 (0.84-1.13) Recent 109 (0.46) 478 (0.41) 1.13 (0.92-1.40) 1.11 (0.89-1.40) Past 199 (0.84) 956 (0.81) 1.04 (0.89-1.21) 1.01 (0.86-1.20) Alendronic acid Non users 23338 (98.93) 116421 (98.99) 1 (Ref.) 1 (Ref.) Current 88 (0.37) 469 (0.40) 0.91 (0.72-1.15) 0.97 (0.76-1.24) Recent 46 (0.19) 201 (0.17) 1.17 (0.84-1.61) 1.18 (0.83-1.66) Past 118 (0.50) 521 (0.44) 1.12 (0.91-1.37) 1.13 (0.91-1.40) Alendronic acid+VitD Non users 23509 (99.66) 117155 (99.61) 1 (Ref.) 1 (Ref.) Current 34 (0.14) 207 (0.18) 0.81 (0.56-1.17) 0.89 (0.60-1.31) Recent 15 (0.06) 77 (0.07) 0.94 (0.54-1.63) 0.71 (0.40-1.29) Past 32 (0.14) 173 (0.15) 0.92 (0.63-1.35) 0.83 (0.56-1.25) Alendronic acid (all ) Non users 23274 (98.66) 116057 (98.68) 1 (Ref.) 1 (Ref.) Current 122 (0.52) 671 (0.57) 0.89 (0.73-1.08) 0.95 (0.77-1.18) Recent 58 (0.25) 261 (0.22) 1.11 (0.83-1.48) 1.03 (0.76-1.39) Past 136 (0.58) 623 (0.53) 1.08 (0.89-1.31) 1.05 (0.86-1.29) Ibandronic acid Non users 23504 (99.64) 117174 (99.63) 1 (Ref.) 1 (Ref.) Current 41 (0.17) 216 (0.18) 0.96 (0.68-1.34) 1.00 (0.70-1.42) Recent 18 (0.08) 69 (0.06) 1.24 (0.74-2.09) 1.38 (0.80-2.36) Past 27 (0.11) 153 (0.13) 0.87 (0.57-1.31) 0.88 (0.57-1.35) Risedronic acid Non users 23355 (99.00) 116446 (99.01) 1 (Ref.) 1 (Ref.) Current 102 (0.43) 527 (0.45) 0.95 (0.76-1.18) 0.99 (0.79-1.25) Recent 47 (0.20) 186 (0.16) 1.27 (0.92-1.75) 1.17 (0.83-1.66) Past 86 (0.36) 453 (0.39) 0.94 (0.75-1.19) 0.93 (0.72-1.19) Conclusion: Our results do not support a cardioprotective effect of BF, regardless of the duration of treatment, age, sex or background cardiovascular risk. Disclosure of Interests: None declared