Maitland-van der Zee Anke Hilse, Klungel Olaf H, Stricker Bruno H Ch, van der Kuip Deirdre A M, Witteman Jacqueline C M, Hofman Albert, Leufkens Hubertus G M, de Boer Anthonius
Department of Pharmacoepidemiology & Pharmacotherapy, Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
Pharm World Sci. 2003 Apr;25(2):70-2. doi: 10.1023/a:1023292830670.
The objective of this study was to determine whether pharmacy records of nitrate prescriptions could be used as a marker of angina pectoris.
This study was conducted within the Rotterdam Study, a prospective follow-up study which started in 1991 and included 7983 elderly subjects. During follow-up, 1601 subjects filled a first prescription for a nitrate and later filled at least one other prescription for nitrates according to pharmacy records. After excluding subjects who started using nitrates in 1991 and who had less than one year of medication history, we took a random sample of 78 subjects (10%). We studied discharge and outpatient cardiologist letters and files from general practitioners for additional information on angina pectoris in these subjects, and allocated patients to one of three categories according to the possibility of the initial diagnosis of angina being correct.
From the random sample of 78, additional information was available on 75 subjects. Definite angina pectoris was present in 33, probable angina pectoris in 18, and possible angina pectoris in 19 subjects. Five subjects had no angina pectoris. Therefore, 93% had at least a possible diagnosis while 68% had at least a probable diagnosis of angina pectoris. The positive predictive value of 2 nitrate prescriptions of which at least one was for rescue therapy was 94%.
We conclude that the use of more than one nitrate prescription can be used as a marker for angina pectoris. This marker may be useful in epidemiological studies.
本研究的目的是确定硝酸盐类药物处方的药房记录是否可作为心绞痛的一个标志物。
本研究在鹿特丹研究中开展，这是一项始于1991年的前瞻性随访研究，纳入了7983名老年受试者。在随访期间，根据药房记录，1601名受试者首次开具了硝酸盐类药物处方，随后又至少开具了一张其他硝酸盐类药物处方。在排除1991年开始使用硝酸盐类药物以及用药史不足一年的受试者后，我们随机抽取了78名受试者（10%）。我们研究了这些受试者的出院小结以及门诊心脏病专家的信件和全科医生的档案，以获取有关心绞痛的更多信息，并根据初诊心绞痛正确的可能性将患者分为三类。
在随机抽取的78名受试者中，有75名受试者可获取更多信息。明确诊断为心绞痛的有33人，可能为心绞痛的有18人，可能患有心绞痛的有19人。5名受试者无心绞痛。因此，93%的受试者至少有患心绞痛的可能诊断，而68%的受试者至少有患心绞痛的很可能诊断。至少有一张用于急救治疗的硝酸盐类药物处方的阳性预测值为94%。
我们得出结论，开具一张以上硝酸盐类药物处方可作为心绞痛的一个标志物。该标志物在流行病学研究中可能有用。
