Cardiovascular morbidity, heart rates and use of antimuscarinics in patients with overactive bladder
Cardiovascular morbidity, heart rates and use of antimuscarinics in patients with overactive bladder
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DOI：
10.1111/j.1464-410x.2009.09073.x
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发表时间：
2010-07-01
影响因子：
4.5
通讯作者：
Kulkarni, Amit S.
中科院分区：
文献类型：
--
作者：
Andersson, Karl-Erik;Sarawate, Chaitanya;Kulkarni, Amit S.
目的 确定患有和不患有膀胱过度活动症 (OAB) 的患者以及治疗和未治疗的 OAB 患者之间心血管 (CV) 合并症和治疗相关的抗毒蕈碱作用是否存在差异，因为 OAB、心血管疾病和接触具有抗毒蕈碱作用的药物在老年患者中很常见。 患者和方法来自 HealthCore 综合研究数据库的有诊断的成人 OAB（国际疾病分类 - 9 代码；从 2000 年 1 月 1 日至 2006 年 12 月 31 日）或抗毒蕈碱 OAB 药物的药房声明，形成了 OAB 队列，进一步分为已治疗和未治疗。既没有诊断为 OAB，也没有任何膀胱功能障碍，也没有抗毒蕈碱药物的药房声称的患者的随机样本组成了非 OAB 队列。在 OAB 诊断/治疗前 12 个月内评估了 CV 合并症和具有抗毒蕈碱作用的药物的使用情况。第一个 OAB 药物处方当天的心率 (HR) 信息是从 GE Healthcare 数据集中获得的。对 1995 年 1 月至 2006 年 11 月期间，年龄≥ 18 岁、诊断为 OAB 并服用任何剂量或口服制剂的抗毒蕈碱药物（奥昔布宁或托特罗定）或口服制剂的患者进行 HR 评估。结果 6607 名 OAB 患者中，很大一部分在基线时 HR 升高，更有可能出现 CV 合并症（39% vs 21%；P < 0.001）以及既往接触过具有抗毒蕈碱作用的药物（33% vs 17%；P < 0.001）的比例高于非 OAB 患者。接受治疗和未接受治疗的 OAB 患者的 CV 合并症发生率（40% vs 38%；P = 0.326）没有差异。然而，之前接触过具有抗毒蕈碱作用的药物存在差异（37% vs 29%；P < 0.001）； 39.1% 的 OAB 患者在开始抗毒蕈碱治疗前心率 > 80 次/分钟。 结论 在这项研究中，患有 OAB 的患者心血管合并症的患病率显着高于无 OAB 的患者； OAB 患者之前接触过具有抗毒蕈碱作用的药物的比例也较高。治疗和未治疗的 OAB 患者之间既往存在的 CV 合并症没有差异，但这些患者大量使用具有抗毒蕈碱作用的药物表明，在使用抗毒蕈碱药物治疗 OAB 之前可能不会考虑 CV 合并症的存在。
OBJECTIVETo determine if cardiovascular (CV) comorbidity and treatment-associated antimuscarinic effects differ between patients with and without overactive bladder (OAB), and between treated and untreated patients with OAB, as OAB, CV disorders and exposure to medications with antimuscarinic effects are common in older patients.PATIENTS AND METHODSAdults from the HealthCore Integrated Research Database with a diagnosis of OAB (International Classification of Diseases-9 codes; from 1 January 2000 to 31 December 2006) or a pharmacy claim for an antimuscarinic OAB medication, formed the OAB cohort, further stratified as treated and untreated. A random sample of patients with neither a diagnosis for OAB nor any urinary bladder dysfunction, nor a pharmacy claim for antimuscarinics, formed the non-OAB cohort. CV comorbidities and use of medications with antimuscarinic effects were assessed for the 12 months before OAB diagnosis/treatment. Information on heart rate (HR) on the day of the first OAB drug prescription was obtained from the GE Healthcare dataset. HR was assessed for patients aged >= 18 years with a diagnosis of OAB who were prescribed antimuscarinics (oxybutynin or tolterodine) at any dose or oral formulation between January 1995 and November 2006.RESULTSThe 6607 patients with OAB, with a substantial proportion with elevated HR at baseline, were more likely to have CV comorbidities (39% vs 21%; P < 0.001) and previous exposure to medications with antimuscarinic effects (33% vs 17%; P < 0.001) than the non-OAB patients. Rate of CV comorbidities (40% vs 38%; P = 0.326) did not differ between treated and untreated patients with OAB. However, there was a difference in previous exposure to medications with antimuscarinic effects (37% vs 29%; P < 0.001); 39.1% of patients with OAB had a HR of > 80 beats/min before starting antimuscarinic treatment.CONCLUSIONIn this study, the prevalence of CV comorbidities was significantly higher in patients with than without OAB; previous exposure to medications with antimuscarinic effects was also higher in patients with OAB. There was no difference in pre-existing CV comorbidities between the treated and untreated patients with OAB, but the high use of medications with antimuscarinic effects among these patients suggests that the presence of CV comorbidity might not be considered before using antimuscarinic agents for OAB.