title: Risk of serious atrial fibrillation and stroke with use of bisphosphonates: evidence from a meta-analysis.
abstract: BACKGROUND
  Clinical studies have suggested an association between bisphosphonate use and the onset of atrial fibrillation (AF). However, data on the risk of developing AF, stroke, and cardiovascular mortality with the use of bisphosphonate are conflicting. The objective of this study was to evaluate the risk of serious AF (events that required hospital admission), stroke, and cardiovascular mortality with the use of bisphosphonates through a systematic review of the literature.
  
  
  METHODS
  We searched the PubMed, CENTRAL, and EMBASE databases for observational studies and randomized controlled trials (RCTs) on the use of bisphosphonates from 1966 to April 2012 that reported the number of patients who developed serious AF, stroke, and cardiovascular mortality at follow-up. The random-effects Mantel-Haenszel test was used to evaluate relative risk-adverse cardiovascular outcomes with the use of bisphosphonates.
  
  
  RESULTS
  Six observational studies (n = 149,856) and six RCTs (n = 41,375) were included for analysis. On pooling observational studies, there was an increased risk of AF (OR, 1.27; 95% CI, 1.16-1.39) among bisphosphonate users. Further, analysis of RCTs revealed a statistically significant increase in the risk of serious AF (OR, 1.40; 95% CI, 1.02-1.93) and no increase in the risk of stroke (OR, 1.07; 95% CI, 0.85-1.34) or cardiovascular mortality (OR, 0.92; 95% CI, 0.68-1.26) with the use of bisphosphonates.
  
  
  CONCLUSIONS
  Evidence from RCTs and observational studies suggests a significantly increased risk of AF requiring hospitalization, but no increase in risk of stroke or cardiovascular mortality, with the use of bisphosphonate.
authors.affiliation: Department of Medicine, Maimonides Medical Center, Brooklyn, NY. Electronic address: abhisheksharma4mamc@gmail.com.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Division of Cardiology, Providence, RI; Providence VA Medical Center and Brown University, Providence, RI.
authors.forename: Saurav
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Armin
authors.initials: A
authors.lastname: Arbab-Zadeh
authors.affiliation: Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Goyal
authors.affiliation: Department of Medicine, Maimonides Medical Center, Brooklyn, NY.
authors.forename: Edgar
authors.initials: E
authors.lastname: Lichstein
authors.affiliation: Division of Cardiology, New York-Presbyterian/Columbia University Medical Center, New York, NY.
authors.forename: Joydeep
authors.initials: J
authors.lastname: Ghosh
authors.affiliation: Division of Cardiology, Lexington VA Hospital, Lexington, KY.
authors.forename: Shamik
authors.initials: S
authors.lastname: Aikat
mesh_terms: D001281:Atrial Fibrillation / Q000139:chemically induced*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects*; D006801:Humans; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000139:chemically induced*
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates