Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics & Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
PLoS One. 2013;8(1):e52991. doi: 10.1371/journal.pone.0052991. Epub 2013 Jan 30.
To compare the incidence rates of serious cardiovascular events in adult initiators of amphetamines or atomoxetine to rates in non-users.
This was a retrospective cohort study of new amphetamines (n=38,586) or atomoxetine (n=20,995) users. Each medication user was matched to up to four non-users on age, gender, data source, and state (n=238,183). The following events were primary outcomes of interest 1) sudden death or ventricular arrhythmia, 2) stroke, 3) myocardial infarction, 4) a composite endpoint of stroke or myocardial infarction. Cox proportional hazard regression was used to calculate propensity-adjusted hazard ratios for amphetamines versus matched non-users and atomoxetine versus matched non-users, with intracluster dependence within matched sets accounted for using a robust sandwich estimator.
The propensity-score adjusted hazard ratio for amphetamines use versus non-use was 1.18 (95% CI: 0.55-2.54) for sudden death/ventricular arrhythmia, 0.80 (95% CI: 0.44-1.47) for stroke, 0.75 (95% CI: 0.42-1.35) for myocardial infarction, and 0.78 (95% CI: 0.51-1.19) for stroke/myocardial infarction. The propensity-score adjusted hazard ratio for atomoxetine use versus non-use was 0.41 (95% CI: 0.10-1.75) for sudden death/ventricular arrhythmia, 1.30 (95% CI: 0.52-3.29) for stroke, 0.56 (95% CI: 0.16-2.00) for myocardial infarction, and 0.92 (95% CI: 0.44-1.92) for stroke/myocardial infarction.
Initiation of amphetamines or atomoxetine was not associated with an elevated risk of serious cardiovascular events. However, some of the confidence intervals do not exclude modest elevated risks, e.g. for sudden death/ventricular arrhythmia.
比较成人安非他命或托莫西汀使用者与非使用者严重心血管事件的发生率。
这是一项新的安非他命（n=38586）或托莫西汀（n=20995）使用者的回顾性队列研究。每个药物使用者都根据年龄、性别、数据源和州与多达四名非使用者相匹配（n=238183）。以下事件是主要感兴趣的结果：1）突然死亡或室性心律失常，2）中风，3）心肌梗死，4）中风或心肌梗死的复合终点。使用 Cox 比例风险回归计算安非他命与匹配非使用者和托莫西汀与匹配非使用者的倾向调整后的风险比，并使用稳健的三明治估计器考虑匹配组内的群内相关性。
与非使用者相比，安非他命使用与非使用的倾向性评分调整后的风险比为 1.18（95%可信区间：0.55-2.54）用于突然死亡/室性心律失常，0.80（95%可信区间：0.44-1.47）用于中风，0.75（95%可信区间：0.42-1.35）用于心肌梗死，0.78（95%可信区间：0.51-1.19）用于中风/心肌梗死。与非使用者相比，托莫西汀使用与非使用的倾向性评分调整后的风险比为 0.41（95%可信区间：0.10-1.75）用于突然死亡/室性心律失常，1.30（95%可信区间：0.52-3.29）用于中风，0.56（95%可信区间：0.16-2.00）用于心肌梗死，0.92（95%可信区间：0.44-1.92）用于中风/心肌梗死。
安非他命或托莫西汀的起始使用与严重心血管事件的风险增加无关。然而，一些置信区间不能排除适度增加的风险，例如突然死亡/室性心律失常。
