Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam, The Netherlands.
Medical library, Academic Medical Center, Amsterdam, The Netherlands.
J Am Med Dir Assoc. 2018 Apr;19(4):371.e1-371.e9. doi: 10.1016/j.jamda.2017.12.013. Epub 2018 Feb 12.
Use of certain medications is recognized as a major and modifiable risk factor for falls. Although the literature on psychotropic drugs is compelling, the literature on cardiovascular drugs as potential fall-risk-increasing drugs is conflicting. The aim of this systematic review and meta-analysis is to provide a comprehensive overview of the associations between cardiovascular medications and fall risk in older adults.
Design: A systematic review and meta-analysis.
Medline, Embase, and PsycINFO. Key search concepts were "fall," "aged," "causality," and "medication." Studies that investigated cardiovascular medications as risk factors for falls in participants ≥60 years old or participants with a mean age of 70 or older were included. A meta-analysis was performed using the generic inverse variance method, pooling unadjusted and adjusted odds ratios (ORs) separately.
In total, 131 studies were included in the qualitative synthesis. Meta-analysis using adjusted ORs showed significant results (pooled OR [95% confidence interval]) for loop diuretics, OR 1.36 (1.17, 1.57), and beta-blocking agents, OR 0.88 (0.80, 0.97). Meta-analysis using unadjusted ORs showed significant results for digitalis, OR 1.60 (1.08, 2.36); digoxin, OR 2.06 (1.56, 2.74); and statins, OR 0.80 (0.65, 0.98). Most of the meta-analyses resulted in substantial heterogeneity that mostly did not disappear after stratification for population and setting. In a descriptive synthesis, consistent associations were not observed.
Loop diuretics were significantly associated with increased fall risk, whereas beta-blockers were significantly associated with decreased fall risk. Digitalis and digoxin may increase the risk of falling, and statins may reduce it. For the majority of cardiovascular medication groups, outcomes were inconsistent. Furthermore, recent studies indicate that specific drug properties, such as selectivity of beta-blockers, may affect fall risk, and drug-disease interaction also may play a role. Thus, studies addressing these issues are warranted to obtain a better understanding of drug-related falls.
某些药物的使用被认为是导致跌倒的一个主要且可改变的风险因素。尽管关于精神类药物的文献令人信服，但关于心血管药物作为潜在增加跌倒风险药物的文献却存在矛盾。本系统评价和荟萃分析的目的是全面概述心血管药物与老年人跌倒风险之间的关系。
设计：系统评价和荟萃分析。
Medline、Embase 和 PsycINFO。主要检索概念为“跌倒”、“年龄”、“因果关系”和“药物”。纳入的研究调查了心血管药物作为≥60 岁参与者或平均年龄为 70 岁或以上的参与者跌倒风险因素。使用通用倒数方差法进行荟萃分析，分别汇总未经调整和调整后的比值比（OR）。
共有 131 项研究纳入定性综合分析。使用调整后的 OR 进行荟萃分析显示，利尿剂（OR 1.36 [1.17, 1.57]）和β受体阻滞剂（OR 0.88 [0.80, 0.97]）的结果具有统计学意义。使用未经调整的 OR 进行荟萃分析显示，洋地黄类药物（OR 1.60 [1.08, 2.36]）、地高辛（OR 2.06 [1.56, 2.74]）和他汀类药物（OR 0.80 [0.65, 0.98]）的结果具有统计学意义。大多数荟萃分析存在显著的异质性，且在按人群和环境分层后，异质性大多并未消失。在描述性综合分析中，并未观察到一致的关联。
利尿剂与跌倒风险增加显著相关，而β受体阻滞剂与跌倒风险降低显著相关。洋地黄类和地高辛可能会增加跌倒风险，而他汀类药物可能会降低跌倒风险。对于大多数心血管药物类别，结果不一致。此外，最近的研究表明，特定药物特性，如β受体阻滞剂的选择性，可能会影响跌倒风险，药物-疾病相互作用也可能起作用。因此，有必要进行研究以更好地了解与药物相关的跌倒。
