Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Department of Clinical Pharmacy, Tergooi Hospital, Hilversum, The Netherlands.
Pharmacoepidemiol Drug Saf. 2021 Jul;30(7):952-959. doi: 10.1002/pds.5220. Epub 2021 Mar 29.
Current guidelines have no sex-specific dosage advice for metoprolol. To evaluate whether women and men are prescribed the same dose a cohort analysis was performed in the population-based Rotterdam Study (RS). Results were replicated in the Integrated Primary Care Information (IPCI) database of automated general practice data.
The mean daily starting doses of metoprolol in both sexes were compared with independent-samples t-tests and a linear regression analysis was used to adjust in the RS for co-variables, notably, cardiovascular comorbidity, migraine, age, SBP, DBP, BMI, socioeconomic status, use of other antihypertensive drugs, smoking, and alcohol. In the IPCI-database, adjustment was for age only.
The mean daily starting dose was statistically significantly lower in women than in men in both the RS and IPCI database, with a mean difference of 4.8 mg (95%CI -7.8, -1.8) and 4.6 mg (95%CI -5.3,-4.0), respectively. Statistical significance remained after adjustment in both databases.
Women received lower starting doses of metoprolol than men in two independent data collections despite non-sex specific cardiovascular guideline recommendations. This example of real-life pharmacotherapy can lead to a form of confounding by contraindication in pharmacoepidemiology.
目前的指南没有针对美托洛尔的具体性别剂量建议。为了评估女性和男性是否使用相同剂量，对基于人群的鹿特丹研究（RS）进行了队列分析。结果在自动化全科医疗数据的综合初级保健信息（IPCI）数据库中得到了复制。
采用独立样本 t 检验比较了男女两性的美托洛尔起始日平均剂量，并使用线性回归分析对 RS 中的协变量（特别是心血管合并症、偏头痛、年龄、SBP、DBP、BMI、社会经济状况、其他抗高血压药物的使用、吸烟和饮酒）进行了调整。在 IPCI 数据库中，仅对年龄进行了调整。
在 RS 和 IPCI 数据库中，女性的美托洛尔起始日平均剂量均显著低于男性，平均差异分别为 4.8 毫克（95%CI-7.8，-1.8）和 4.6 毫克（95%CI-5.3，-4.0）。在两个数据库中进行调整后，统计学意义仍然存在。
尽管有非性别特异性心血管指南建议，但在两个独立的数据集中，女性接受的美托洛尔起始剂量均低于男性。这种真实药物治疗的例子可能会导致药物流行病学中的禁忌症混杂。
