Cardiovascular morbidity, heart rates and use of antimuscarinics in patients with overactive bladder

Abstract

bladder dysfunction, nor a pharmacy claim for antimuscarinics, formed the non-OAB cohort. CV comorbidities and use of medications with antimuscarinic effects were assessed for the 12 months before OAB diagnosis/treatment. Information on heart rate (HR) on the day of the first OAB drug prescription was obtained from the GE Healthcare dataset. HR was assessed for patients aged ≥ 18 years with a diagnosis of OAB who were prescribed antimuscarinics (oxybutynin or tolterodine) at any dose or oral formulation between January 1995 and November 2006. RESULTSThe 6607 patients with OAB, with a substantial proportion with elevated HR at baseline, were more likely to have CV comorbidities (39% vs 21%; P < 0.001) and previous exposure to medications with antimuscarinic effects (33% vs 17%; P < 0.001) than the non-OAB patients. Rate of CV comorbidities (40% vs 38%; P = 0.326) did not differ between treated and untreated patients with OAB. However, there was a difference in previous exposure to medications with antimuscarinic effects (37% vs 29%; P < 0.001); 39.1% of patients with OAB had a HR of > 80 beats/min before starting antimuscarinic treatment. CONCLUSIONIn this study, the prevalence of CV comorbidities was significantly higher in patients with than without OAB; previous exposure to medications with antimuscarinic effects was also higher in patients with OAB. There was no difference in pre-existing CV comorbidities between the treated and untreated patients with OAB, but the high use of medications with antimuscarinic effects among these patients suggests that the presence of CV comorbidity might not be considered before using antimuscarinic agents for OAB.

The effect of tolterodine 4 and 8 mg on the heart rate variability in healthy subjects

“…This might be especially important considering that the incidence of OAB, and subsequently the incidence of antimuscarinic drug treatment, also increase with age [4,5]. Together, these conditions and the well-established relationships between age, increasing HR, and mortality/morbidity rates can make patients with OAB and concomitant cardiovascular diseases more vulnerable to the cardiac side-effects of antimuscarinics [11].…”

“…In addition, a recent study showed that the prevalence of cardiovascular comorbidities is significantly higher in patients with than without OAB and that previous exposure to medications with antimuscarinic effects was also higher in patients with OAB [11].…”

“…This might be of little relevance for a healthy heart, but patients with cardiac comorbidities or impaired cardiac autonomic regulation might be at risk for cardiovascular events [9,11]. A recent cohort study showed that elevated resting HR (rHR) is an independent predictor for myocardial infarction or coronary death [12].…”

How to treat the frail elderly: The challenge of multimorbidity and polypharmacy

“…12,13 Importantly, the various available antimuscarinics are metabolized differently, with some agents metabolized through the hepatic cytochrome P450 system. This is particularly important to be aware of for patients taking multiple medications, as many common drugs are also inducers, inhibitors or substrates of the various isoenzymes of this system.…”

Überaktive Blase, Neurourologie, Urogynäkologie und Belastungsinkontinenz

“…Dieser Trend konnte auch in der Subanalyse einzelner kardiovaskulär bedingter Erkrankungen bestätigt werden. Im Rahmen dieser retrospektiven Studie untersuchten Andersson et al [1] ebenfalls die möglicherweise negativen Auswirkungen einer antimuskarinergen Therapie auf kardiovaskuläre Komorbiditäten. Sie Fazit.…”