5 research outputs found
Effect of Tetracyclines on the Development of Vascular Disease in Veterans with Acne or Rosacea: A Retrospective Cohort Study
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Methotrexate reduces incidence of vascular diseases in veterans with psoriasis or rheumatoid arthritis
Methotrexate (MTX) is a folate analogue used in the treatment of moderate to severe psoriasis and rheumatoid arthritis (RA). It oppositely affects inflammation and hyperhomocysteinemia—two independent risk factors for vascular disease. To date, there are no published reports evaluating the impact of these potentially paradoxical action of MTX.
The purpose of this study was to evaluate the effect of MTX therapy on the incidence of vascular disease in patients with psoriasis and RA.
We conducted a retrospective cohort study in which we analyzed computerized records of 7,615 outpatients diagnosed with psoriasis and 6,707 with RA at the Veterans Integrated Service Network 8.
Patients prescribed MTX therapy had a significantly reduced risk of vascular disease compared to those who were not prescribed MTX (psoriasis: RR
=
0.73, 95% CI
=
0.55–0.98; RA: 0.83, 0.71–0.96). This reduction was most evident for patients prescribed a low cumulative dose of MTX (psoriasis: RR
=
0.50, 95% CI
=
0.31–0.79; RA
=
0.65, 0.52–0.80). Concomitant use of folic acid (FA) with MTX also reduced the incidence of vascular disease in patients prescribed MTX (psoriasis: RR
=
0.56, 95% CI
=
0.39–0.80; RA: 0.77, 0.38–1.56).
MTX therapy reduced the incidence of vascular disease in veterans with psoriasis or RA. Low to moderate cumulative dose appears more beneficial than the higher dose. We hypothesize that this effect is caused by its anti-inflammatory properties. In addition, a combination of MTX and FA led to a further reduction in the incidence of vascular disease
The epidemiology of ocular surface squamous neoplasia in a Veterans Affairs population
PURPOSE: To evaluate the epidemiology of ocular surface squamous neoplasia (OSSN) and its associated risk factors in a South Florida Veterans Affairs Hospital population. DESIGN: Retrospective case-control study. METHODS: PARTICIPANTS: 28 confirmed cases of OSSN from 24,179 veterans who received care at the Miami Veterans Affairs Healthcare System (VA) and affiliated satellite eye clinics between March 1, 2007, and March 1, 2012. METHODS: Data extracted from the veterans administration database comprised of demographic information and medical diagnosis information (based on International Classification of Disease (ICD-9) codes). MAIN OUTCOME MEASURES: The period prevalence of OSSN and identification of factors associated with the presence of disease. RESULTS: The period prevalence of OSSN in our population was 0.1%. Studied risk factors included ultra-violet (UV)-related dermatologic diseases (melanoma, squamous and basal cell cancer, and actinic keratosis), UV-related ocular conditions (pterygium). human immunodeficiency virus (HIV) seropositivity, human papilloma virus (HPV)-related diseases, and tobacco use. The presence of a skin malignancy (squamous cell carcinoma (SCC) and/or basal cell carcinoma (BCC)) and pterygium were found to be significantly associated with the presence of OSSN (odds ratio (OR) 4.40, 95% confidence interval (CI) 2.03–9.55, p <0.0005 and OR 16.2 95% CI 7.11–36.9, p <0.0005, respectively). CONCLUSIONS: The presence of neoplasias and ocular conditions related to sun exposure were the most important risk factors for the presence of OSSN in a South Florida VA population consistent with previous epidemiological reports worldwide
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Chronic kidney disease stages 3–5 and cardiovascular disease in the veterans affairs population
Cardiovascular complications are common in patients with chronic kidney disease in the general population. The study aims to investigate the prevalence and prognosis of CKD stages 3–5 in the veterans affairs (VA) population, which is sicker with more co-morbid conditions.In this case-controlled study of 6,432 men the associations of risk factors with CKD and its risk of mortality were estimated using, primarily, logistic regression analysis.The 1,045 (16.2%) patients with CKD stages 3–5 were older (72 ± 10 vs. 59 ± 13 years, P < 0.0001) with more hypertension (53.6 vs. 39.6%, P < 0.0001), diabetes (24.9 vs. 19.8%, P < 0.0002), and CVD (35.3 vs. 17.8%, P < 0.0001) at baseline. Age ≥65 years (odds ratio [95% CI]) (4.95 [4.22–5.82]), hypertension (1.56 [1.34–1.79]), diabetes mellitus (1.21 [1.03–1.43]), CVD (1.71 [1.47–2.00]), and White not Hispanic (1.57 [1.32–1.85]) were independently associated with CKD. The prevalence of CVD at baseline increased with decreasing renal function. Old age (1.98 [1.66–2.35]), CKD (1.94 [1.61–2.33], CVD (1.46 [1.23–1.74]) and tobacco use (1.91 [1.05–3.47]) were independently associated with the 750 (11.7%) deaths.Among veterans, traditional cardiovascular risk factors, CVD, and CKD are highly prevalent. CKD is associated with increased risk of baseline CVD and follow-up mortality