isotretinoin and Cardiovascular-Diseases

Isotretinoin is widely used in the treatment of acne vulgaris and other dermatological diseases. Numerous side effects have been reported in the literature. A myocardial bridge occurs when segments of the coronary artery create an intramyocardial tunnel. Atherosclerotic plaque formation frequently occurs in the segment proximal to a myocardial bridge. Coronary thrombus formation, which is often the cause of myocardial infarction in young patients, can be triggered by many factors. Kounis syndrome is described as acute coronary syndromes associated with allergic or hypersensitivity reactions. This article is a description of the case of a patient predisposed to the development of a thrombus by a myocardial bridge who was successfully treated for coronary thrombosis and which may represent a case of Kounis syndrome associated with isotretinoin use presented in the context of the relevant literature.

Topics: Adult; Cardiovascular Diseases; Dermatologic Agents; Electrocardiography; Humans; Isotretinoin; Kounis Syndrome; Male

In 2001, we reported that mortality may have been higher with isotretinoin (30 mg/d for 3 years) than with placebo in the subgroup of current smokers among the 1,166 patients with definitively resected early-stage non-small cell lung cancer who participated in the randomized, controlled Lung Intergroup Trial. We report the overall and cause (cancer, cardiovascular disease, or other)-specific mortality associated with long-term isotretinoin after an extended median follow-up of 6.2 years that included the capture of cause-of-death data from 428 deceased patients. Overall mortality was 36.7% in each of the two trial arms, about two thirds related to cancer and one third to other or unknown causes. Overall and cancer deaths increased in current smokers in the isotretinoin arm during the treatment and the extended follow-up period. No mortality end point increased among never smokers and former smokers taking isotretinoin, and cancer deaths decreased marginally in this combined subgroup. Isotretinoin also increased deaths from cardiovascular disease in current smokers. The present analysis supports the safety of protracted isotretinoin use in the combined group of never smokers and former smokers, which has important public health implications, for example, for treating acne in young people. The increased mortality in current smokers in this study is further evidence of the multifaceted danger of active smoking. The overall indications of this study have public health implications for treating acne in young people and other uses of retinoids in smokers.

Topics: Acne Vulgaris; Aged; Antineoplastic Agents; Carcinoma, Non-Small-Cell Lung; Cardiovascular Diseases; Cause of Death; Cocarcinogenesis; Combined Modality Therapy; Disease-Free Survival; Female; Follow-Up Studies; Humans; Infections; Isotretinoin; Kaplan-Meier Estimate; Lung Neoplasms; Male; Middle Aged; Neoplasms; Pneumonectomy; Proportional Hazards Models; Smoking

Case reports suggest that isotretinoin use is associated with an increased risk of cardiovascular disorders; however, the clinical significance has not been determined.. To determine whether isotretinoin increases the risk of cardiovascular outcomes.. A case crossover study was performed among subjects who filled ≥1 isotretinoin prescription during 1984-2003. Cases were defined as those with a first-ever diagnosis or hospitalization for acute myocardial infarction (MI), stroke, phlebitis/thrombophlebitis, pulmonary embolism (PE) or thrombosis. Exposure to isotretinoin in a 5-month hazard period immediately prior to the index date (calendar date of the diagnosis or hospitalization for the study outcomes) was compared to a 5-month control period. Odds ratios (ORs) along with 95% confidence intervals (CIs) were estimated using conditional logistic regression.. Of 30,496 isotretinoin users identified, 872 (3%) cases met the inclusion criteria; 381 (43.7%) had a stroke, 268 (30.7%) phlebitis/thrombophlebitis, 133 (15.3%) MI, 61 (7.0%) PE and 29 (3.3%) thrombosis. When stratified according to type of outcome, ORs were 0.75 (95% CI: 0.38-1.47), 1.31 (95% CI: 0.64-2.69) and 2.00 (95% CI: 0.50-8.00) for stroke, phlebitis/thrombophlebitis and MI, respectively.. No statistically significant association was found between isotretinoin and cardiovascular, cerebrovascular and thromboembolic outcomes.

Topics: Adult; Cardiovascular Diseases; Case-Control Studies; Cerebrovascular Disorders; Cross-Over Studies; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Middle Aged; Risk; Thromboembolism; Young Adult

In many studies, an increase in total cholesterol and triglycerides with isotretinoin therapy have been shown and investigators have commented on potential cardiovascular risk. A low intake of linoleic acid, the main essential fatty acid in man, may act as an independent risk factor for coronary heart disease. In vitro etretin alters both the incorporation of extracellular fatty acids into cell membranes and the fatty acid composition of the cell membrane itself. It is, therefore, important to establish whether isotetinoin has any effect on the metabolism of polyunsaturated fatty acids.. The effect of treatment with isotretinoin for 4 months on the metabolism of polyunsaturated fatty acids in patients with acne was assessed. Quantitative total cholesterol and triglycerides as well as plasma phospholipid, triglycerides, and cholesteryl ester fatty acids were measured in 12 patients and red cell phosphatidylethanolamine, phosphatidylcholine, and phosphatidylinositol fatty acids were measured in 13 patients before and after isotretinoin therapy.. There was a significant increase in the concentrations of cholesterol (P < 0.02) and triglycerides (P < 0.04) during treatment. There was no significant difference is plasma phospholipids, triglycerides, and cholesterol esters, or in the red cell phosphatidylethanolamine, phosphatidylcholine, and phosphatidylinositol during isotretinoin therapy.. This study failed to demonstrate any effect of isotretinon on the metabolism of polyunsaturated fatty acids. There was a significant increase in total cholesterol and triglyceride levels following isotretinoin therapy supporting the findings of many previous studies.

Topics: Acne Vulgaris; Adolescent; Adult; Cardiovascular Diseases; Cholesterol; Fatty Acids; Female; Humans; Isotretinoin; Keratolytic Agents; Lipids; Male; Risk Factors; Triglycerides