[show abstract][hide abstract] ABSTRACT: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used; however, they are also nephrotoxic with both acute and chronic effects on kidney function. Here we determined NSAID prescribing before and after estimated GFR (eGFR) reporting and evaluate renal function in patients who used NSAIDs but stopped these after their first eGFR report. A population-based longitudinal analysis using a record-linkage database was conducted with the GFR estimated using the four-variable equation from the MDRD study and analyzed by trend test, paired t-test, and logistic regression modeling. Prescriptions for NSAIDs significantly decreased from 39,459 to 35,415 after implementation of eGFR reporting from the second quarter of 2005 compared with the first quarter of 2007. Reporting eGFR was associated with reduced NSAID prescriptions (adjusted odds ratio, 0.78). NSAID prescription rates in the 6 months before April 2006 were 18.8, 15.4, and 7.0% in patients with CKD stages 3, 4, and 5 and 15.5, 10.7, and 6.3%, respectively, after eGFR reporting commenced. In patients who stopped NSAID treatment, eGFR significantly increased from 45.9 to 46.9, 23.9 to 27.1, and 12.4 to 26.4 ml/min per 1.73 m(2) in 1340 stage 3 patients, 162 stage 4 patients, and 9 stage 5 patients, respectively. Thus, NSAID prescribing decreased after the implementation of eGFR reporting, and there were significant improvements in estimated renal function in patients who stopped taking NSAIDs. Hence, eGFR reporting may result in safer prescribing.Kidney International advance online publication, 13 March 2013; doi:10.1038/ki.2013.76.
Kidney International 03/2013; · 7.92 Impact Factor
[show abstract][hide abstract] ABSTRACT: : This study was carried out to determine whether pregnancy rate is reduced after appendicitis or appendicectomy.
: The association between appendicectomy, appendicitis, and subsequent fertility is controversial.
: A cohort study was carried out in the Medicines Monitoring database. The cohort of women who underwent appendicectomy and appropriate comparators were followed up until first pregnancy after appendicectomy date. Pathology of the appendix was verified manually. The association between appendicectomy, appendicitis, and pregnancy was determined by Cox regression models.
: The age and social deprivation score-matched analyses included 2935 patients who had appendicectomy with 5870 comparators. There were 1277 (43.5%) pregnancies in the appendicectomy cohort and 2319 (39.5%) in the comparator cohort during a mean follow-up of 12.4 (standard deviation: 7.3) years. The adjusted hazard ratios (HRs) for pregnancy rates were 1.20 (95% confidence interval [CI]: 1.10-1.31). In an unmatched cohort analysis (3009 in the appendicectomy cohort and 122,912 in the comparator cohort), the adjusted HRs for pregnancy rates were 1.65 (95% CI: 1.55-1.75). Within the histologically proven appendicitis subset, the adjusted HR was 1.21 (95% CI: 1.08-1.37) in comparison with the matched comparator cohort. In comparison with the group of participants who had appendicectomy for a normal appendix, the HRs were 0.98 (95% CI: 0.83-1.15) for mucosal and catarrhal appendicitis, 0.72 (95% CI: 0.64-0.82) for suppurative appendicitis, and 0.64 (95% CI: 0.50-0.80) for gangrenous appendicitis.
: Appendicectomy and early appendicitis were associated with increased pregnancy rates. Young women with early appendicitis had better pregnancy rates than those with advanced appendicitis. Early referral for laparoscopy and appendicectomy is advocated.
Annals of surgery 12/2012; 256(6):1039-44. · 7.90 Impact Factor
[show abstract][hide abstract] ABSTRACT: To study whether subsequent pregnancy rate is reduced after appendicectomy.
A cohort study was carried out in the General Practice Research Database, a United Kingdom primary care database.
Female patients who underwent appendicectomy between 1986 and 2009 and appropriate comparators were followed until first pregnancy.
The association between appendicectomy and subsequent pregnancy was determined by Cox regression models.
The analyses included 76,426 appendicectomy patients, with 152,852 comparators from the database. There were 30,030 pregnancies (39.3%) in the appendicectomy cohort and 43,321 (28.3%) in the comparator cohort during a mean (SD) follow-up of 10.5 (6.6) years. Adjusted hazard ratios for subsequent birth rates were 1.54 (95% confidence interval, 1.52-1.56).
Appendicectomy was associated with increased subsequent pregnancy rate in this study. This suggests that a history of appendicectomy is not associated with impaired fertility.
Fertility and sterility 06/2012; 98(2):401-5. · 3.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: In the UK, clinicians usually make treatment decisions based on total cholesterol (TC) at the same time supplemented with high-density lipoprotein cholesterol (HDL-C) measurements. We evaluated statin-associated TC concentration change and its impact on cardiovascular (CV) risk reduction in diabetic patients in the setting of usual care.
In a population-based cohort study using a record-linkage database in Tayside, Scotland. we studied 6,697 diabetic patients who had at least two separate TC measurements between 1993 and 2007. Patients were categorized into statin-exposed and statin-unexposed groups according to statin use status during the follow-up. The main outcomes were TC concentration change from baseline, CV events, and all-cause mortality during the follow-up. Multivariate Cox regression models with a time-dependent variable for statins were employed to assess outcome risk.
Statin-associated TC concentrations decreased by 1.64 mmol/L (28%) in patients without CV disease (CVD) (5,984) and 1.19 mmol/L (23%) in patients with CVD (713) from 5.90 mmol/L and 5.20 mmol/L at baselines, respectively. Statin use reduced incident and recurrent CV events by 39% and 41%, respectively [adjusted hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.57-0.66; 0.59 95% CI 0.47-0.76) per millimole of TC reduction. For all-cause mortality, the adjusted HRs were 0.39 (95% CI 0.32-0.47) in primary prevention and 0.58 (95% CI 0.42-0.80) in secondary prevention.
Statin use was as effective in diabetic patients in the setting of usual care, as in the clinical trials, in both primary and secondary prevention. TC changes can be used as a measure of statin efficacy in the absence of low-density lipoprotein cholesterol (LDL-C) in diabetic patients.
European Journal of Clinical Pharmacology 02/2012; 68(8):1201-8. · 2.74 Impact Factor
[show abstract][hide abstract] ABSTRACT: The benefit of statin use on total cholesterol (TC) concentration has not been studied previously in patients with chronic obstructive pulmonary disease (COPD).
Our study aimed to evaluate statin-associated TC-concentration reduction and subsequent risk for cardiovascular (CV) morbidity and mortality in COPD.
We performed a population-based cohort study using a record-linkage database in Tayside, Scotland. A total of 1017 COPD patients who had at least 2 separate TC measurements between 1993 and 2007 were studied. They were categorized into statin-exposed and statin-unexposed groups according to their statin use status during follow-up. Main outcomes were TC-concentration change from baseline, CV events, and all-cause mortality during follow-up. Multivariate Cox regression models with a time-dependent variable for statins were used to assess risk for outcomes.
Statin-associated TC concentrations decreased by 0.86 mmol/L (16%) in patients treated for primary prevention (PP) (n = 1274) and 0.52 mmol/L (11%) in patients treated for secondary prevention (SP) (n = 443), from 5.30 mmol/L and 4.68 mmol/L at baseline, respectively. TC concentrations also declined by 2% in patients free from established CV disease and by 5% in patients with established CV disease in the statin-unexposed groups. A risk reduction of recurrent CV events with statins was observed (adjusted hazard ratio [HR] = 0.35; 95% CI, 0.15-0.87), but not for PP (adjusted HR = 0.84; 95% CI, 0.37-1.89). Statins reduced CV mortality (adjusted HR = 0.32; 95% CI, 0.13-0.77) in SP but not PP. There were statistically significant reductions in all-cause mortality in both PP (adjusted HR = 0.61; 95% CI, 0.43-0.85) and SP (adjusted HR = 0.58; 95% CI, 0.35-0.97).
In patients with COPD, statins were protective from CV events and CV mortality in SP but not PP, and statins improved all-cause mortality in both PP and SP.
[show abstract][hide abstract] ABSTRACT: To understand public and general practitioner (GP) opinion on the acceptability of randomized policy design (RPD) studies (cluster randomized trials) of prescription medicines in Scotland.
We surveyed public opinion on the concept of RPD studies in a sample of 1040 adults to determine acceptability and understand how people feel when changes are made to their medicines. We also surveyed GPs (n = 1034) about the concept of RPD studies as a tool for improving understanding of comparative effectiveness and safety of medicines in the 'usual care' setting.
Thirty per cent of people would be happy to receive a letter about randomized policy changes to their therapy, 31% would not mind or had no opinion and 39% would be unhappy. This view was sensitive to the reason for change; effectiveness and safety reasons were most acceptable (96%) and cost saving least acceptable (39%). Only 19% thought randomized policy change was not an acceptable method of determining the best treatments. Eighty-one per cent of respondents were willing for their medical data to be followed up to compare drug treatments (further 10% undecided). Participants reporting long-term medical conditions and those reporting previous changes to drug therapy were more in favour of RPD studies than other participants. Thirty-three per cent (n = 341) of GPs responded to our survey. Of these, 45% were in favour of RPD studies, 19% were undecided and 36% not in favour.
The public in Scotland is broadly supportive of the concept of randomized policy design studies of medicines, while there is a spread of opinion among GPs.
British Journal of Clinical Pharmacology 01/2012; 74(2):354-61. · 3.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: To investigate whether exposure to spironolactone treatment affects the risk of incident breast cancer in women over 55 years of age.
Retrospective, matched cohort study.
General Practice Research Database, a primary care anonymised database representative of the general population in the United Kingdom.
1,290,625 female patients, older than 55 years and with no history of breast cancer, from 557 general practices with a total follow-up time of 8.4 million patient years. We excluded patients with poor quality data and those with no contacts with their general practitioner after their current registration date.
Exposed cohort included women who received at least two prescriptions of spironolactone after age 55 years, who were followed up from the first prescription (index date). We randomly selected two unexposed female controls for every exposed patient, matched by practice, year of birth, and socioeconomic scores (if information was available), and followed up from the same date.
New cases of breast cancer, using Read codes to confirm diagnoses.
Index dates for study patients ranged from 1987 to 2010, and 29,491 new cases of breast cancer were recorded in the study population (incidence rate 0.35% per year). The exposed cohort of 28,032 patients and control cohort of 55,961 patients had unadjusted incidence rates of 0.39% and 0.38% per year, respectively, over a mean follow-up time of 4.1 years. Time-to-event analysis, adjusting for potential risk factors, provided no evidence of an increased incidence of breast cancer in patients exposed to spironolactone (hazard ratio 0.99, 95% confidence interval 0.87 to 1.12).
These data suggest that the long term management of cardiovascular conditions with spironolactone does not increase the risk of breast cancer in women older than 55 years with no history of the disease.
[show abstract][hide abstract] ABSTRACT: The aim of this study was to investigate the effect of renin-angiotensin system blockade on outcomes in patients with aortic regurgitation (AR).
Angiotensin-converting enzyme (ACE) inhibitors have the potential to reduce afterload, blunt left ventricular wall stress, and limit left ventricular dilation and hypertrophy. However, long-term studies have yielded inconsistent results, and very few have assessed clinical outcomes.
The Health Informatics Centre dispensed prescription and morbidity and mortality database for the population of Tayside, Scotland, was linked through a unique patient identifier to the Tayside echocardiography database. Patients diagnosed with at least moderate AR from 1993 to 2008 were identified. Cox regression analysis was used to assess differences in all-cause mortality and cardiovascular (CV) and AR events (heart failure hospitalizations, heart failure deaths, or aortic valve replacement) between those treated with and without ACE inhibitors or angiotensin receptor blockers (ARBs).
A total of 2,266 subjects with AR (median age 74 years; interquartile range: 64 to 81 years) were studied, with a mean follow-up period of 4.4 ± 3.7 years. Seven hundred and five patients (31%) received ACE inhibitor or ARB therapy. There were 582 all-cause deaths (25.7%). Patients treated with ACE inhibitors or ARBs had significantly lower all-cause mortality and fewer CV and AR events, with adjusted hazard ratios of 0.56 (95% confidence interval [CI]: 0.64 to 0.89; p < 0.01) for all-cause mortality, 0.77 (95% CI: 0.67 to 0.89; p < 0.01) for CV events, and 0.68 (95% CI: 0.54 to 0.87; p < 0.01) for AR events.
This large retrospective study shows that the prescription of ACE inhibitors or ARBs in patients with moderate to severe AR was associated with significantly reduced all-cause mortality and CV and AR events. These data need to be confirmed by a prospective randomized controlled outcome trial.
Journal of the American College of Cardiology 11/2011; 58(20):2084-91. · 14.09 Impact Factor
[show abstract][hide abstract] ABSTRACT: There is increasing prevalence of hypercholesterolemia among patients with osteoarthritis (OA) and rheumatoid arthritis (RA). We examined the effectiveness of statins on total cholesterol (TC), cardiovascular (CV) morbidity, and mortality in patients with OA or RA.
A population-based cohort study was done using a record-linkage database in Tayside, Scotland. In total, 2024 OA or RA patients who had at least 2 separate TC measurements between 1993 and 2007 were studied. They were categorized into statin-exposed and statin-unexposed groups according to statin use status during followup. The main outcomes were TC concentration change from baseline, CV events, and all-cause mortality during the followup. Multivariate Cox regression models with a time-dependent variable for statins were employed to assess the risk of outcomes.
Statin-associated TC concentrations in OA decreased by 15% in patients without CV disease (primary prevention, n = 1269) and 7% in patients with CV disease (secondary prevention, n = 247) from baseline of 5.30 mmol/l and 4.54 mmol/l, respectively. Correspondingly, in RA TC was reduced by 16% (n = 430) and 15% (n = 78) with baselines of 5.54 mmol/l and 4.95 mmol/l. In primary prevention, statins were associated with reduced CV events and all-cause mortality in RA patients [adjusted HR 0.45 (95% CI 0.20-0.98) and 0.43 (95% CI 0.20-0.92), respectively] and all-cause mortality in OA patients [adjusted HR 0.43 (95% CI 0.25-0.72)]. Statins were not associated with reduced risk of CV events or all-cause mortality in the secondary prevention of RA or OA patients [adjusted HR 0.68 (95% CI 0.30-1.54) and 0.52 (95% CI 0.20-1.34) for OA patients, and HR 0.58 (95% CI 0.07-4.79) and 0.79 (95% CI 0.18-3.53) for RA patients].
Statins reduced TC concentrations between 7% and 16% in patients with OA or RA. Statins were associated with reduced CV events and mortality in RA and mortality in OA in primary prevention.
The Journal of Rheumatology 11/2011; 39(1):32-40. · 3.26 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to investigate the impact of renin-angiotensin system blockade therapy on outcomes in aortic stenosis (AS).
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are perceived to be relatively contraindicated in AS. However, inhibitors of the renin-angiotensin system may be beneficial in AS through their cardioprotective and beneficial effects on left ventricular remodeling.
The Health Informatics dispensed prescribing, morbidity, and mortality database for the population of Tayside, Scotland, was linked through a unique patient identifier to the Tayside echocardiography database (>110,000 scans). Patients with a diagnosis of AS from 1993 to 2008 were identified. Cox regression model (adjusted for confounding variables) and propensity score analysis were used to assess the impact of ACEIs or ARBs on all-cause mortality and cardiovascular (CV) events (CV death or hospitalizations).
A total of 2,117 patients with AS (mean age 73 ± 12 years, 46% men) were identified and 699 (33%) were on ACEI or ARB therapy. Over a mean follow-up of 4.2 years, there were 1,087 (51%) all-cause deaths and 1,018 (48%) CV events. Those treated with ACEIs or ARBs had a significantly lower all-cause mortality with an adjusted hazard ratio of 0.76 (95% confidence interval: 0.62 to 0.92, p < 0.0001) and fewer CV events with an adjusted hazard ratio of 0.77 (95% confidence interval: 0.65 to 0.92, p < 0.0001). The outcome benefits of ACEIs/ARBs were further supported by propensity score analysis.
This large observational study suggests that ACEI/ARB therapy is associated with an improved survival and a lower risk of CV events in patients with AS.
Journal of the American College of Cardiology 08/2011; 58(6):570-6. · 14.09 Impact Factor
[show abstract][hide abstract] ABSTRACT: Issues surrounding data security and privacy are of great importance when handling sensitive health-related data for research. The emphasis in the past has been on balancing the risks to individuals with the benefit to society of the use of databases for research. However, a new way of looking at such issues is that by optimising procedures and policies regarding security and privacy of data to the extent that there is no appreciable risk to the privacy of individuals, we can create a 'win-win' situation in which everyone benefits, and pharmacoepidemiological research can flourish with public support. We discuss holistic measures, involving both information technology and people, taken to improve the security and privacy of data storage.
After an internal review, we commissioned an external audit by an independent consultant with a view to optimising our data storage and handling procedures.
Improvements to our policies and procedures were implemented as a result of the audit.
By optimising our storage of data, we hope to inspire public confidence and hence cooperation with the use of health care data in research.
Pharmacoepidemiology and Drug Safety 06/2011; 20(8):885-93. · 2.90 Impact Factor
[show abstract][hide abstract] ABSTRACT: To characterize patients with urate measurements by urate-lowering therapy (ULT) use and to study the impact of allopurinol treatment on cardiovascular and mortality outcomes.
A cohort study using a record-linkage database. The study included 7135 patients aged ≥60 years with urate measurements between 2000 and 2002 followed up until 2007. A Cox regression model was used. The association between urate levels, dispensed allopurinol and cardiovascular hospitalization and mortality was determined.
Six thousand and forty-two patients were not taking ULT and 45.9% of those (2774 of 6042) had urate concentrations ≤6 mg dl(-1) . Among 1035 allopurinol users, 44.7% (45.6% for men and 43.3% for women) reached target urate concentration. There was no significant increased risk of cardiovascular events for allopurinol users when compared with non-ULT users [adjusted hazard ratio (HR) 1.10, 95% confidence interval (CI) 0.95-1.26] and the non-ULT group with urate >6 mg dl(-1) (adjusted HR 1.07, 95% CI 0.89-1.28). Within the allopurinol use cohort, cardiovascular event rates were 74.0 (95% CI 61.9-86.1) per 1000 person years for the 100 mg group, 69.7 (49.6-89.8) for the 200 mg group and 47.6 (38.4-56.9) for the ≥300 mg group. Compared with low-dose (100 mg) users, high-dose (≥300 mg) users had significant reductions in the risk of cardiovascular events (adjusted HR 0.69, 95% CI 0.50-0.94) and mortality (adjusted HR 0.75, 95% CI 0.59-0.94).
Less than 50% of patients taking allopurinol reached target urate concentration. Higher doses of allopurinol were associated with better control of urate and lower risks of both cardiovascular events and mortality.
British Journal of Clinical Pharmacology 04/2011; 71(4):600-7. · 3.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT * Recruitment is key to the success of clinical trials. * Many clinical trials fail to achieve adequate recruitment. * Public understanding and engagement in clinical research could be improved. WHAT THIS STUDY ADDS * 'Get Randomised' is the first campaign of its kind in the UK. * It is possible to improve public awareness of clinical research using the media. * Further work is needed to determine whether improved public awareness leads to increased participation in clinical research in the future. AIM To increase public awareness and understanding of clinical research in Scotland. METHODS A generic media campaign to raise public awareness of clinical research was launched in 2008. The 'Get Randomised' campaign was a Scotland-wide initiative led by the University of Dundee in collaboration with other Scottish universities. Television, radio and newspaper advertising showed leading clinical researchers, general practitioners and patients informing the public about the importance of randomised clinical trials (RCTs). 'Get Randomised' was the central message and interested individuals were directed to the http://www.getrandomised.org website for more information. To assess the impact of the campaign, cross-sectional surveys were conducted in representative samples of 1040 adults in Scotland prior to campaign launch and again 6 months later. RESULTS There was an improvement in public awareness of clinical trials following the campaign; 56.7% [95% confidence interval (CI) 51.8, 61.6] of the sample recalled seeing or hearing advertising about RCTs following the campaign compared with 14.8% (10.8, 18.9) prior to the campaign launch (difference = 41.4%; 95% CI for difference 35.6, 48.3; P < 0.01). Of those who recalled the advertising, 49% felt that the main message was that people should take part more in medical research. However, on whether they would personally take part in a clinical trial if asked, there was little difference in response following the campaign ['yes' 31.3% (28.4, 34.1) prior; 30.4% (27.6, 33.2) following; difference =-0.9%; 95% CI for difference -4.8, 3.1%; P= 0.92]. CONCLUSIONS It is possible to raise public awareness of clinical research using the media, but further efforts may be required to influence individuals' decisions to take part in clinical research.
British Journal of Clinical Pharmacology 02/2010; 69(2):128-35. · 3.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to evaluate how total cholesterol (TC) concentration in subjects treated with statins predicts myocardial infarction (MI) risk in the absence of low density lipoprotein cholesterol (LDL-C) measurement in clinical trials and in the setting of usual care.
A systematic review of published English language randomised clinical trials comparing statins with placebo that reported TC changes in subjects with or without prior MI between 1993 and 2008 was carried out using Medline, the Cochrane Library, Web of Science and the ISI Web of Knowledge. In addition, a cohort study of MI patients who had at least two TC measurements in Tayside, Scotland, between 1989 and 2002 was performed. The main outcome was TC concentration changes and risk of subsequent MI.
In the meta-analyses of secondary and primary prevention trials statins decreased TC by 1.54 mmol/L and 1.37 mmol/L versus placebo. Statin-associated TC reduction translated into a risk reduction of 18% per mmol (RR 0.82; 95%CI 0.72-0.93) for secondary prevention and 24% per mmol (RR 0.76; 95%CI 0.62-0.93) for primary prevention. In the cohort study, statin use reduced TC by 0.98 mmol/L compared with non statin-use. Statin use was associated with a 28% reduction (adjusted HR 0.72; 95%CI 0.51-0.98) for recurrent MI.
Total cholesterol measurements can be used with confidence in the absence of LDL measurements to make decisions about statin drug introduction or titration. Randomised trials of statin therapy had good external validity and cholesterol changes and outcomes in trials were comparable to those observed in the setting of usual care.
European Journal of Clinical Pharmacology 10/2009; 65(11):1071-80. · 2.74 Impact Factor
[show abstract][hide abstract] ABSTRACT: To characterize adherence in patients with established cardiovascular disease taking statins and aspirin and to estimate the effects of adherence due to health behaviour, a lack of beneficial drug effect, or both on recurrence of cardiovascular disease or all-cause mortality over 10 years.
A population-based cohort study using a record-linkage database in Tayside, Scotland. Subjects with cardiovascular disease (n = 7657; 4185 aspirin-alone cohort, 671 statin-alone cohort and 2801 combination use cohort) were studied between 1993 and 2003. The effects of adherence on recurrence of cardiovascular disease or mortality were assessed using Poisson regression model.
In subjects taking both aspirin and statins, those adherent to statins but not aspirin had a lower risk of recurrence [adjusted risk ratio (RR) 0.64; 95% confidence interval 0.49, 0.82], but those adherent to aspirin but not statins has no such effect (adjusted RR 0.91; 0.72, 1.15), suggesting that adherence behaviour alone was not responsible for the beneficial effect. Within the group adherent to aspirin, > or =80% adherence to statins was associated with reduced recurrence compared with those poorly adherent (adjusted RR 0.76; 0.62, 0.94), but no such effect of aspirin was seen in those adherent to statins. Similar results were found for all-cause mortality.
Poor health behaviour is not a sufficient explanation of adverse outcome in poorly adherent patients. Adverse outcome is more likely to be driven by foregone drug benefits.
British Journal of Clinical Pharmacology 07/2008; 66(1):110-6. · 3.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: Laboratory studies and studies in normal volunteers have suggested a possible adverse interaction between aspirin and ibuprofen. It is thought that ibuprofen prevents aspirin from gaining access to platelet cyclooxygenase. Following the publication of these studies, a number of observational and other studies have been published. We review these studies identified by structured searching of Medline and Pubmed databases. We conclude that on the balance of probabilities that ibuprofen is more likely to interact with aspirin than not. This interaction is more likely in those who take ibuprofen chronically and is more important in those at high cardiovascular risk. Thus, a reasonable strategy might be to advise aspirin takers to avoid chronic ibuprofen.
[show abstract][hide abstract] ABSTRACT: To compare the social and demographic profiles of patients who receive statin treatment after myocardial infarction and patients included in randomised trials. To estimate the effect of statin use in community based patients on subsequent all cause mortality and cardiovascular recurrence, contrasting effects with trial patients.
Observational cohort study using a record linkage database.
Tayside, Scotland (population size and characteristics: about 400,000, mixed urban and rural).
4892 patients were discharged from hospital after their first myocardial infarction between January 1993 and December 2001. 2463 (50.3%) were taking statins during an average follow-up of 3.7 years (3.1% in 1993 and 62.9% in 2001).
All cause mortality and recurrence of cardiovascular events.
319 deaths occurred in the statin treated group (age adjusted rate 4.1 per 100 person years, 95% confidence interval 3.2 to 4.9), and 1200 in the statin untreated group (12.7 per 100 person years, 11.1 to 14.3). More older people and women were represented in the population of patients treated with statins than among those recruited into clinical trials (mean age 67.8 v 59.8; women 39.6% v 16.9%, respectively). The effects of statins in routine clinical practice were consistent with, and similar to, those reported in clinical trials (adjusted hazard ratio for all cause mortality 0.69, 95% confidence interval 0.59 to 0.80; adjusted hazard ratio for cardiovascular recurrence 0.82, 0.71 to 0.95).
The community effectiveness of statins in those groups that were not well represented in clinical trials was similar to the efficacy of statins in these trials.
BMJ (Clinical research ed.). 05/2005; 330(7495):821.
[show abstract][hide abstract] ABSTRACT: To characterise those who receive beta-blocker therapy after MI and to estimate the effect of adherence to beta-blocker use on subsequent mortality and recurrent MI.
A community-based observational cohort study was done using a record linkage database. Patients were those discharged from hospitals after their first MI between January 1994 and December 1995 and who also survived for at least 1 year. The outcome was all cause mortality and recurrent MI. Results were adjusted for age, sex, social deprivation, airways disease, peripheral vascular disease (PVD), diabetes mellitus, cardiovascular drug use, steroid use and hospitalisation for cardiovascular disease using a logistic regression model and a Cox regression model.
A total of 865 patients were included in this study. 386 (44.6%) were on beta-blocker treatment during the year after MI. Beta-blocker use was lower amongst high-risk patients (older patients, patients with obstructive airway disease, PVD and those with a previous hospitalisation for heart failure). Mortality was lower in patients treated with beta-blockers compared with those untreated. Good adherence (>or=80%) was associated with a lower adjusted relative risk of mortality compared with unexposed patients (0.49, 95%CI 0.30-0.80, p < 0.01). Within the high-risk subgroup of patients, the adjusted relative risk of mortality with good adherence was 0.40 (0.17-0.93, p = 0.03).
Beta-blocker use was lower in older patients, patients with airways disease, PVD and heart failure, but these patients appeared to have the greatest benefit from beta-blockers. Good adherence to beta-blocker treatment after MI was associated with a lower risk of mortality.
Pharmacoepidemiology and Drug Safety 11/2004; 13(11):761-6. · 2.90 Impact Factor