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- Merlo, Juan, et al.
(författare)
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Incidence of myocardial infarction in elderly men being treated with antihypertensive drugs: population based cohort study
- 1996
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Ingår i: BMJ. - 0959-8138. ; 313:7055, s. 457-461
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To analyse the association between use of antihypertensive treatment, diastolic blood pressure, and long term incidence of ischaemic cardiac events in elderly men. DESIGN: Population based cohort study. Baseline examination in 1982-3 and follow up for up to 10 years. SETTING: Malmo, Sweden. SUBJECTS: 484 randomly selected men born in 1914 and living in Malmo during 1982. MAIN OUTCOME MEASURES: Observational comparisons of incidence rates and rate and hazard ratios of ischaemic cardiac events (myocardial infarction or death due to chronic ischaemic cardiac disease). RESULTS: The crude incidence rate of ischaemic cardiac events was higher in those subjects who were taking antihypertensive drugs than in those who were not (rate ratio 2.6 (95% confidence interval 1.7 to 3.9)). After adjustment for potential confounders (differences in baseline smoking habits, blood pressure, time since diagnosis of hypertension, ischaemic or other cardiovascular disease, hypercholesterolaemia, hypertriglyceridaemia, diabetes mellitus, obesity, and raised serum creatinine concentration) this rate was reduced but still raised (hazard ratio 1.9 (1.0 to 3.7)). In men with diastolic blood pressure > 90 mm Hg, antihypertensive treatment was associated with a twofold increase in the incidence of ischaemic cardiac events (rate ratio 2.0 (1.1 to 3.6)), which vanished after adjustment for potential confounders (hazard ratio 1.1 (0.5 to 2.6)). In those subjects with diastolic blood pressure < or = 90 mm Hg, antihypertensive treatment was associated with fourfold increase in incidence (rate ratio 3.9 (2.1 to 7.1)), which remained after adjustment for potential confounders (hazard ratio 3.8 (1.3 to 11.0)). CONCLUSION: Antihypertensive treatment may increase the risk of myocardial infarction in elderly men with treated diastolic blood pressures < or = 90 mm Hg.
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- Merlo, Juan, et al.
(författare)
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Increased risk of ischaemic heart disease mortality in elderly men using anxiolytics-hypnotics and analgesics. Results of the 10-year follow-up of the prospective population study "Men born in 1914", Malmo, Sweden
- 1996
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Ingår i: European Journal of Clinical Pharmacology. - 1432-1041. ; 49:4, s. 261-265
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: An increased risk of all-cause and cardiovascular mortality in users of anxiolytic-hypnotic drugs (AHD) has been reported, and use of analgesics may be an additional factor. Therefore, we examined the association of AHD and analgesic use, alone and in combination, with all-cause and ischaemic heart disease (IHD) mortality. METHODS: Multivariate 10-year survival analysis in a population based cohort of 500 men born in 1914. Relative risks (RR) were adjusted by relevant confounders (blood pressure, serum cholesterol, diabetes mellitus, smoking habit, high alcohol consumption, history of previous IHD, cancer, and other diseases). RESULTS: The RR of both all-cause and IHD mortality were significantly increased among those using both AHD and analgesics compared to those who took neither of these drugs: RR = 1.8 for all-cause mortality, and RR = 2.7 for IHD mortality. CONCLUSION: Although the number of cases was small, warranting interpretative caution, the current study suggests that the combined use of AHD (mainly benzodiazepines) and analgesics seems to be associated with an increase in all-cause and IHD mortality in elderly men.
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| 5. |
- Merlo, Juan
(författare)
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Pharmacoepidemiologic studies on cardiovascular drugs - with special reference to the effectiveness and safety of blood pressure lowering drugs
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Ischaemic heart disease (IHD) and stroke are the main causes of morbidity and mortality in developed countries and hence constitute a large public health problem. Cardiovascular drugs are used in an effort to prevent (e. g. blood pressure lowering drugs (BPLD) and lipid lowering drugs) and palliate (e. g. nitrates) these disorders. The efficacy and safety of these drugs have been evaluated in randomised clinical trials. However, conclusions from these trials are not representative of patients in general. This necessitates epidemiologic studies to evaluate the long-term effectiveness and risk of cardiovascular drugs in routine care. Methods: 283 Swedish municipalities were studied during 1989 - 1993 by multivariate Poisson regression at the ecologic level. Drug utilisation was categorised into four equal-size groups by quartiles and compared with mortality from IHD and stroke. The relation between stroke mortality and utilisation of BPLD was also analysed in 49 municipalities by correlation of direct age standardised (equivalent average rate method) rates. At the individual level, the incidence of ischaemic cardiac events and stroke in relation to the use of BPLD and blood pressure level was analysed in a prospective population based cohort of 500 men born 1914 and living in Malmö in 1982-83 by multivariate 10-year survival analysis. Results: Compared with the municipalities within the lowest fourth of drug utilisation, mortality from IHD and stroke was reduced in the three other fourths of lipid-lowering drugs utilisation. Only the municipalities within the uppermost BPLD utilisation had a lower IHD (-5%) and stroke mortality (-10%). Utilisation of nitrates was associated with a gradually increased risk of mortality from stroke (+3%, +7%, +11%) and an increased risk of mortality from IHD (+10%, +9%, +13%). At the individual level, use of BPLD was associated with increased incidence of ischaemic cardiac events both in those with diastolic blood pressure above, and in those at or below, 90 mmHg. However, after adjustment for confounders the two-fold risk increase among the former disappeared, whereas the four-fold risk increase among the latter remained. Systolic blood pressure <160 mmHg conveyed a lower risk of stroke, but this benefit was only seen in untreated men. In men being treated with BPLD the opposite was true, the risk of stroke being increased almost threefold. Main conclusions: Both BPLD and lipid lowering drugs seemed to be effective in the general population, but the effectiveness of routine treatment with BPLD appeared to be low; reduced IHD and stroke mortality was reached in only one fourth of the municipalities. This need not indicate a suboptimal utilisation level of BPLD but rather that various factors may counteract their effects in routine care. The safety of nitrates should be further analysed as they might enhance the risk of IHD and stroke mortality. A plausible explanation of the increased risk in BPLD users with low blood pressure is that it was confined to a subgroup of subjects not represented in randomised clinical trials in whom lowering of blood pressure could be detrimental (the J-curve phenomenon).
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- Merlo, Juan, et al.
(författare)
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Utilization of cardiovascular drugs (blood pressure lowering drugs, lipid lowering drugs and nitrates) and mortality from ischaemic heart disease and stroke. An ecological analysis based on Sweden's municipalities
- 1999
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 55:1, s. 69-76
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To perform an ecological study in an effort to generate questions concerning the preventive impact of various cardiovascular drugs on mortality from stroke and ischaemic heart disease (IHD) in the community, and to explore the association between sales of nitrates and mortality from stroke and IHD. METHODS: Out-patient drug utilization (sales) of blood pressure lowering drugs, lipid lowering drugs and nitrates were categorized in four groups of equal size by quartiles and compared with mortality from IHD and stroke, using the group of municipalities with the lowest utilization as reference, from 1989 to 1993 in 283 of Sweden's 288 municipalities, by Poisson regression. Adjustments were made for population size, age and gender proportions, the utilization rate of cardiovascular drugs other than the tested drug group and location of the municipality. RESULTS: Compared with the group of municipalities with the lowest sales and adjusting only for population size, mortality from IHD and stroke increased with the extent of utilization of blood pressure lowering drugs and nitrates. In contrast, mortality decreased with increased utilization of lipid lowering drugs. After further adjustments by percentage of men, age structure, geographical location (mid-points) of the municipalities, and, as a proxy for cardiovascular disease, the sales of cardiovascular drugs other than the tested drug group, the increased risk associated with blood pressure lowering drugs disappeared, and there was a dose-response association between sales of diuretics and old antihypertensives and decreasing mortality, sales of nitrates continued to be associated with an increased risk, and the low mortality risk associated with sales of lipid lowering drugs persisted. CONCLUSION: Lipid lowering drugs may have a preventive impact in the general population, but the preventive impact of blood pressure lowering drugs, with the exception of diuretics and old antihypertensives, may be low in many municipalities. The safety of nitrates needs more investigation at the individual level.
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