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Use of antidiabetic and antidepressant drugs is associated with increased risk of myocardial infarction: a nationwide register study
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis.
The George Institute for Global Health, University of Sydney, NSW, Australia.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, "Primary Health Care in Motala".
2016 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, no 2, 218-223 p.Article in journal (Refereed) Published
Abstract [en]

Aims

To explore the gender- and age-specific risk of developing a first myocardial infarction in people treated with antidiabetic and/or antidepressant drugs compared with people with no pharmaceutical treatment for diabetes or depression.

Methods

A cohort of all Swedish residents aged 45–84 years (n = 4 083 719) was followed for a period of 3 years. Data were derived from three nationwide registers. The prescription and dispensing of antidiabetic and antidepressant drugs were used as markers of disease. All study subjects were reallocated according to treatment and the treatment categories were updated every year. Data were analysed using a Cox regression model with a time-dependent variable. The outcome of interest was first fatal or non-fatal myocardial infarction.

Results

During follow-up, 42 840 people had a first myocardial infarction, 3511 of which were fatal. Women aged 45–64 years, receiving both antidiabetic and antidepressant drugs had a hazard ratio for myocardial infarction of 7.4 (95% CI 6.3–8.6) compared with women receiving neither. The corresponding hazard ratio for men was 3.1 (95% CI 2.8–3.6).

Conclusions

The combined use of antidiabetic and antidepressant drugs was associated with a higher risk of myocardial infarction compared with use of either group of drugs alone. The increase in relative risk was greater in middle-aged women than in middle-aged men.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016. Vol. 33, no 2, 218-223 p.
National Category
Public Health, Global Health, Social Medicine and Epidemiology Other Health Sciences Family Medicine
Identifiers
URN: urn:nbn:se:liu:diva-121285DOI: 10.1111/dme.12822ISI: 000370161800011PubMedID: 26036276OAI: oai:DiVA.org:liu-121285DiVA: diva2:853093
Note

Funding agencies: King Gustaf V and Queen Victoria Freemason Foundation

Available from: 2015-09-11 Created: 2015-09-11 Last updated: 2017-04-24Bibliographically approved
In thesis
1. Cardiovascular risk factors in elderly: With special emphasis on atrial fibrillation, hypertension and diabetes
Open this publication in new window or tab >>Cardiovascular risk factors in elderly: With special emphasis on atrial fibrillation, hypertension and diabetes
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

The part of the population that belongs to the oldest-old (ages 80 years or older) increases rapidly, worldwide. Cardiovascular disease (CVD) is the leading cause of death and disease burden globally. Multimorbidity is common in old age and stroke, diabetes mellitus (DM) and atrial fibrillation (AF) are strongly associated with age. Cardiovascular risk factors are well studied and documented in younger and middle ages, but not as well in old and frail individuals. Therefore, preventive treatment choices are mostly based on evidence for younger patients. The aim of this thesis was to explore age and other aspects of cardiovascular risk factors; AF, hypertension and DM, in relation to comorbidity, cardiovascular outcome and mortality.

Methods

This thesis was based on four different studies:

  • The ELSA85 study of 85 years old in Linköping, Sweden
  • The international, multicentre, randomised controlled INTERACT2 trial of spontaneous intracranial haemorrhage (ICH), mean age 64 years.
  • The prospective SHADES study of nursing home residents, mean age 85 years.
  • The prospective, national SWE-diadep study of dispensed antidiabetics, antidepressantsand prevalent myocardial infarction (MI) in 45-84 years old.

Data was obtained from questionnaires (ELSA85, INTERACT2), medical records and medical examination (ELSA85, INTERACT2, SHADES), and national registers (SWE-Diadep).

Results

The ELSA85 study showed that 16% (n=53) had an ECG showing AF. There was an increased hazard ratio (HR) for all-cause mortality in participants with AF at baseline, at 90 years of age (HR 1.59, 95% [Confidence Interval] CI 1.04-2.44) adjusted for sex. This increase in HR did not persist when adjusted for congestive heart failure (CHF). In the INTERACT2 study, increasing age was associated with increasing frequency of death or dependency (odds ratio [OR] 4.36, 95% [CI] 3.12-6.08 for >75 years vs <52 years, p value for trend <0.001). The SHADES study showed that participants with Systolic blood pressure (SBP) <120 mmHg had an increased HR for mortality (1.56, 95% CI, 1.08–2.27; p=0.019) but there were no differences between SBP groups 140–159 mmHg and ≥160 mmHg compared with the reference group SBP 120–139 mmHg. SBP decreased during the prospective study period. In the SWE-diadep study, individuals with antidiabetics and antidepressants combined had a greater HR for MI compared to the reference of no antidiabetics or antidepressants, mostly so in women aged 45-64 years (HR 7.4, 95% CI: 6.3-8.6).

Conclusion

Risk factors for CVDs in elderly differ from cardiovascular risk factors in middle aged individuals an

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 78 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1466
National Category
Public Health, Global Health, Social Medicine and Epidemiology Other Health Sciences Family Medicine
Identifiers
urn:nbn:se:liu:diva-121286 (URN)10.3384/diss.diva-121286 (DOI)978-91-7519-030-3 (ISBN)
Public defence
2015-10-09, Belladonna, ingång 78, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-09-11 Created: 2015-09-11 Last updated: 2015-09-18Bibliographically approved

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Rådholm, KarinWiréhn, Ann-BrittÖstgren, Carl Johan

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