DRUG THERAPY EFFECT ON REINFARCTION RISK IN WOMEN

心脏病的研究主要集中在1960年和1970年。 与“过早”动脉粥样硬化相关的危险因素 在患有心脏病的上班族中年男性中表现得尤为明显 袭击或突然死亡。对“早产儿”疾病的关注是一种 重要的开始，但它导致了对学习的相对忽视 在老年人和所有女性中。冠心病残留物 然而，这是导致妇女发病和死亡的主要原因。这个 本课题的主要目的是评价钙离子通道的安全性。 阻滞剂在女性心肌梗塞二级预防中的应用。 鉴于临床试验中一致的发现，钙通道 心肌梗死后应用阻滞剂不会降低 死亡或再梗塞的风险，这类药物可能 实际上增加了风险，未来不太可能对此进行试验 将对女性进行治疗。然而，钙通道阻滞剂 在心肌梗死后的女性中使用频率越来越高。 对这些药物的安全性进行研究的唯一道德方法 女性的药物是通过观察性研究得出的。正在进行的研究 普吉特集体卫生合作社妇女的激素替代治疗 Sound(GHC)已经确认了所有遭受首次感染的女性参与者 自1986年以来心脏病发作；拟议的项目将扩大这一初始阶段 一直持续到1996年。来自病历审查和GHC的信息 数据库将被用来评估风险因素和共病情况 在进入队列时和在长达10年的后续行动中，以及 以确定反复发生的心血管事件和死亡。一个完整的 随访期内处方药接触情况的记录如下 从GHC计算机化药房数据库中为每个受试者获取。 尽管主要假设与女性的再梗塞风险有关，但男性 也将进行研究，以便于比较这一结果 观察性研究与临床试验的研究。根据 保守估计可用样本量，我们将有86% 仅在女性中检测相对风险的权力为1.45，而检测相对风险的权力为85% 检测男性和女性合计的相对风险为1.25，对于 钙通道阻滞剂的使用与致命性或非致命性的关系 再梗死。只需额外的工作即可完成 适当的分析，本项目还将检查安全性和 女性术后常用其他心血管药物的疗效观察 心肌梗死，包括血管紧张素转换酶 抑制剂、降脂药物和雌激素替代疗法。数据 来自观察性研究，如提出的一项，可以帮助指导 临床实践，并可帮助设计适当的第二次 对妇女进行预防试验。

Research on heart disease in the 196Os and 197Os was primarily concerned with risk factors for "premature" atherosclerosis, which was most dramatically apparent in working middle-aged men who suffered heart attacks or died suddenly. This focus on "premature" disease was an important initial step, but it resulted in a relative neglect of studies in older adults and in all women. Coronary heart disease remains nonetheless a major cause of morbidity and mortality among women. The primary goal of this project is to evaluate the safety of calcium-channel blockers in the secondary prevention of myocardial infarction in women. Given the consistent findings from clinical trials that calcium-channel blockers administered following myocardial infarction do not decrease the risk of death or reinfarction, and that some drugs of this class may actually increase the risk, it is unlikely that future trials of this therapy in women will be conducted. Yet the calcium-channel blockers are used with increasing frequency in women following myocardial infarction. The only ethical method of conducting studies of the safety of these drugs in women is through observational studies. On-going studies of hormone-replacement therapy in women at Group Health Cooperative of Puget Sound (GHC) have identified all female enrollees who suffered a first heart attack since 1986; the proposed project will expand this inception cohort through 1996. Information from medical record review and GHC databases will be used to assess risk factors and co-morbid conditions both at entry into the cohort and during up to l0 years of follow-up, and to identify recurrent cardiovascular events and deaths. A complete record of prescription drug exposure during the follow-up period will be obtained for each subject from the GHC computerized pharmacy database. Although the main hypothesis relates to reinfarction risk in women, men will be studied as well to facilitate comparison of the results of this observational study with those of the clinical trials. According to conservative estimates of the available sample size, we will have 86% power to detect a relative risk of 1.45 in women alone, and 85% power to detect a relative risk of 1.25 in men and women combined, for the association of calcium-channel blocker use with fatal or non-fatal reinfarction. With only the additional work required to do the appropriate analyses, this project will also examine the safety and efficacy of other cardiovascular drugs commonly used in women after myocardial infarction, and these include angiotensin converting-enzyme inhibitors, lipid-lowering drugs, and estrogen replacement therapy. Data from observational studies such as the one proposed can help to guide clinical practice and can assist in the design of appropriate secondary prevention trials ill women.