BACKGROUND:Rosuvastatin and atorvastatin are the two primary high-intensity statins used for cardiovascular risk reduction. However, concerns have been raised regarding the renal safety profile of rosuvastatin. This study compared risks of hematuria, proteinuria, and cardiovascular events between rosuvastatin- and atorvastatin-treated patients. METHODS:This is a retrospective cohort study of atorvastatin and rosuvastatin users from 1 January 2018 to 31 December 2021. Inverse probability of treatment weighting was used to mitigate confounding. Poisson regression models were used to estimate adjusted relative risks. RESULTS:Of 136,680 patients (median age 61 years, 42.6% female), 46,292 were treated with atorvastatin and 90,388 rosuvastatin. During follow-up, there were 619 cases of proteinuria, 1843 cases of hematuria, and 19 cases of end-stage renal disease. Compared with atorvastatin, rosuvastatin was associated with a nonsignificant increase in the risk of hematuria (adjusted risk ratio [aRR] 1.1, 95% confidence interval [CI] 0.98-1.24) and proteinuria (aRR 1.02, 95% CI 0.83-1.25). Risk of cardiovascular events was significantly lower with rosuvastatin (aRR 0.77, 95% CI 0.70-0.83). Rosuvastatin was associated with a lower risk of myocardial infarction (aRR 0.75, 95% CI 0.63-0.91) and stroke (aRR 0.76, 95% CI 0.62-0.94) but not heart failure (aRR 0.82, 95% CI 0.63-1.06). Significant cardiovascular risk reduction was observed with rosuvastatin in the first 6 months. CONCLUSIONS AND RELEVANCE:Compared with atorvastatin, rosuvastatin was associated with a significantly lower risk of cardiovascular events and a nonsignificant increase in hematuria and proteinuria. Overall, the cardiovascular benefits of rosuvastatin appear to outweigh the minor renal risks.

Background: Nonagenarians represent a growing population in the United States. Cardiac stress testing is commonly used for risk stratification in patients with chest pain. However, there is limited evidence on the benefits of stress testing in nonagenarians. Aims: The goal of this study was to investigate the utilization of cardiac stress testing in nonagenarian evaluated in outpatient clinics for chest pain, and to evaluate the incremental prognostic value of stress testing in this population. Methods: This is a retrospective observational study that included patients 90 years and above who presented for outpatient evaluation of chest pain. Referral for cardiac stress testing was captured using electronic health records. Patients were followed for one year. The associations between cardiac stress testing and subsequent cardiac catheterization, coronary revascularization, and myocardial infarction were evaluated using logistic regression models. Results: Between 2017 and 2021, 11763 patients 90 years and above presented to a clinic visit with a chief complaint of chest pain. There were 50.3% male, 61.4% White, 9.0% Black, 20.0% Hispanic, and 9.3% Asian. In this group, 320 (2.7%) underwent cardiac stress testing. Patients referred for testing had fewer cardiac risk factors, with a lower prevalence of hypertension, hyperlipidemia, and diabetes. At one year of follow-up, 6.9% of patients in the stress test group underwent cardiac catheterization, compared to 2.5% of patients in the no testing group (adjusted OR 2.87, 95% CI 1.81-4.57). Revascularization occurred in 0.63% patients in the stress testing group compared to 0.78% in the no testing group (adjusted OR 0.78, 95% CI 0.19-3.21). Myocardial infarction occurred in 3.4% in the stress testing group compared to 4.4% in the no testing group (adjusted OR 1.67, 95% CI 0.79-2.9). Conclusion: Among nonagenarians who underwent outpatient evaluation of chest pain, cardiac stress testing was associated with a significantly increased odds of subsequent cardiac catheterization, but no difference in revascularization or myocardial infarction. These observations suggest the clinical benefits of stress testing in nonagenarians may be limited.

ObjectiveThe goal of this study is to determine the strength of association between treatment with triptans and acute myocardial infarction, heart failure, and death.BackgroundCase reports in the literature have raised concerns over an association between treatment of migraine headaches with triptans and cardiovascular events. This study aims to systematically evaluate this association in a contemporary population‐based cohort. We hypothesized that triptan exposure is not associated with increased cardiovascular events.MethodsA retrospective cohort study was conducted within an integrated healthcare delivery system in Southern California. From January 2009 to December 2018, 189,684 patients age ≥18 years had a diagnosis of migraine. In this group, 130,656 were exposed to triptans. Patients treated with triptans were matched 1:1 to those not exposed to triptans by using a propensity score. The primary outcome was acute myocardial infarction; secondary outcomes were heart failure, all‐cause death, and combined acute myocardial infarction, heart failure, and death.ResultsThe incidence rate of acute myocardial infarction was 0.67 per 1000 person‐year in triptan‐exposed vs 1.44 per 1000 person‐year in not exposed patients. In propensity‐matched analyses, the adjusted hazard ratio for triptan exposure was 0.95 (95% confidence interval [CI] 0.84‐1.08) for acute myocardial infarction; 1.00 (95% CI 0.93‐1.08) for all‐cause death; 0.93 (95% CI 0.81‐1.08) for heart failure; and 0.99 (95% CI 0.93‐1.06) for a composite of acute myocardial infarction, heart failure, or death. Sensitivity analyses focusing on stratified subgroups based on age, gender, ethnicity, and several cardiac risk factors also revealed no significant association between triptan exposure and cardiovascular events.ConclusionsNo association was found between exposure to triptans and an increased risk of cardiovascular events. These data provide reassurance regarding the cardiovascular safety of utilizing triptans for the medical management of migraine headaches.

Case reports have suggested isotretinoin exposure may be associated with adverse cardiac events. There are limited data where the cardiovascular safety of isotretinoin is systematically evaluated. The aim of this study was to determine the strength of association between isotretinoin exposure and adverse cardiovascular events. This was a population-based retrospective cohort study within an integrated healthcare delivery system. Adults ≥ 18 years of age with acne between 2009 and 2018 were included. Exposure to isotretinoin was identified using pharmacy records, and propensity score 1:1 matching was performed. The primary outcome was a composite of cardiovascular outcomes, including acute myocardial infarction, heart failure, and all-cause death. The cohort consisted of 12,140 adults (10.5%) exposed to isotretinoin and 103,126 adults who were never exposed. Mean follow-up was 7.1 ± 2.9 years. After propensity score 1:1 matching, 23,844 patients were included. The rates of the composite cardiovascular outcomes were 0.47 versus 0.48 per 1000 person-years in the isotretinoin and non-exposed groups, respectively. No significant association was observed between isotretinoin treatment and the composite cardiovascular outcomes (adjusted hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.62–1.58), all-cause mortality (adjusted HR 1.10, 95% CI 0.62–1.95), acute myocardial infarction (adjusted HR 1.00, 95% CI 0.33–3.09), congestive heart failure (adjusted HR 0.45, 95% CI 0.14–1.40), or atrial fibrillation (adjusted HR 0.44, 95% CI 0.12–1.65). Among adult patients with acne, no association was found between exposure to isotretinoin and an increased risk of cardiovascular events. Physicians should not be discouraged from prescribing isotretinoin out of concern for cardiovascular effects.

Anomalous coronary arteries are a relatively rare finding that may be asymptomatic or follow classical courses that often necessitate surgical intervention due to hemodynamic consequences. Less frequently encountered anomalies may still need investigation for surgery, especially in the setting of

Cardiovascular computed tomographic angiography (CCTA) provides a 3-dimensional (3D) individualized ‘‘virtual patient avatar’’ useful for diagnosis, decision-making, and virtual visualization of surgical approaches. We present images from a 62-year-old male with bicuspid aortic valve with multiple associated aortic anomalies who underwent CCTA for virtual surgical planning. The CCTA demonstrated a bicuspid aortic valve, aortic root aneurysm (4.6 5.1 cm), severe coarctation of the aorta with a minimal residual connection measuring 4 mm, narrow necked (6 mm), saccular aneurysm of an intercostal artery (3.0 2.7 cm) arising off the descending aorta distal 1 Division of Cardiovascular Medicine/CardioVascular Thoracic Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA