RTI Health Solutions, Barcelona, Spain.
RTI Health Solutions, Research Triangle Park, North Carolina.
Pharmacotherapy. 2018 Jun;38(6):628-637. doi: 10.1002/phar.2121.
Blocking muscarinic receptors could have an effect on cardiac function, especially among elderly patients with overactive bladder (OAB).
To investigate the risk of cardiovascular (CV) events in users of antimuscarinic drugs to treat OAB.
DESIGN, SETTING, AND PARTICIPANTS: Cohort study of new users of darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, or trospium, 18 years or older, in the United Kingdom's Clinical Practice Research Datalink (CPRD), 2004-2012.
Using tolterodine as the reference, we estimated propensity-score-stratified incidence rate ratios (IRRs) for acute myocardial infarction, stroke, CV mortality, major adverse cardiac events (MACE, a combined end point of the previous three), and all-cause death for individual antimuscarinic drugs. The study cohort included 119,912 new users of OAB drugs. The mean age at cohort entry was 62 years, 70% were female, and the mean follow-up was 3.3 years. The adjusted IRR for MACE and current use of oxybutynin compared with current use of tolterodine was 1.14 (95% confidence interval [CI] 1.01-1.30). In contrast, the IRR was 0.65 (CI 0.56-0.76) for current use of solifenacin compared with tolterodine. In this study, performed with health care data, the distribution of risk factors was relatively similar across users of different OAB drugs and, although our analyses controlled for a range of measured potential confounders, residual confounding cannot be ruled out.
In an observational comparative study of users of medications to treat OAB conducted in routine clinical practice, the risk for CV side effects was increased in users of oxybutynin and decreased in users of solifenacin compared with users of tolterodine.
阻断毒蕈碱受体可能会对心脏功能产生影响，尤其是在患有膀胱过度活动症（OAB）的老年患者中。
研究用于治疗 OAB 的抗毒蕈碱药物使用者发生心血管（CV）事件的风险。
设计、设置和参与者：这是一项在英国临床实践研究数据链接（CPRD）中，对 2004 年至 2012 年间新使用达非那新、非索罗定、奥昔布宁、索利那新、托特罗定或托特罗定的 18 岁及以上年龄的患者进行的队列研究。
以托特罗定为参照，我们估计了急性心肌梗死、中风、CV 死亡率、主要不良心脏事件（MACE，前三个的联合终点）和全因死亡率的个体抗毒蕈碱药物的倾向评分分层发生率比（IRR）。该研究队列包括 119912 名新诊断为 OAB 药物的患者。入组时的平均年龄为 62 岁，70%为女性，平均随访时间为 3.3 年。与当前使用托特罗定相比，当前使用奥昔布宁的 MACE 和调整后的 IRR 为 1.14（95%置信区间[CI]1.01-1.30）。相比之下，当前使用索利那新的 IRR 为 0.65（CI 0.56-0.76）。在这项使用医疗保健数据进行的观察性比较研究中，不同 OAB 药物使用者的危险因素分布相对相似，尽管我们的分析控制了一系列潜在的混杂因素，但仍不能排除残余混杂因素。
在常规临床实践中对治疗 OAB 药物的使用者进行的观察性比较研究中，与托特罗定相比，奥昔布宁使用者发生 CV 副作用的风险增加，而索利那新使用者发生 CV 副作用的风险降低。
