TY - JOUR
T1 - Women are started on a lower daily dose of metoprolol than men irrespective of dose recommendations:
T2 - A potential source of confounding by contraindication in pharmacoepidemiology
AU - Hendriksen, Linda C.
AU - Verhamme, Katia M. C.
AU - Van der Linden, Paul D.
AU - Stricker, Bruno H.
AU - Visser, Loes E.
N1 - Funding information: ZonMw, Grant/Award Number: 849200006; IMI 2, Grant/Award Number: 116030
PY - 2021/3/6
Y1 - 2021/3/6
N2 - Purpose: Current guidelines have no sex-specific dosage advice for metoprolol. To evalu-ate whether women and men are prescribed the same dose a cohort analysis was per-formed in the population-based Rotterdam Study (RS). Results were replicated in theIntegrated Primary Care Information (IPCI) database of automated general practice data.Methods: The mean daily starting doses of metoprolol in both sexes were comparedwith independent-samples t-tests and a linear regression analysis was used to adjustin the RS for co-variables, notably, cardiovascular comorbidity, migraine, age, SBP,DBP, BMI, socioeconomic status, use of other antihypertensive drugs, smoking, andalcohol. In the IPCI-database, adjustment was for age only.Results: The mean daily starting dose was statistically significantly lower in womenthan 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 significanceremained after adjustment in both databases.Conclusions: Women received lower starting doses of metoprolol than men in twoindependent data collections despite non-sex specific cardiovascular guideline rec-ommendations. This example of real-life pharmacotherapy can lead to a form of con-founding by contraindication in pharmacoepidemiology
AB - Purpose: Current guidelines have no sex-specific dosage advice for metoprolol. To evalu-ate whether women and men are prescribed the same dose a cohort analysis was per-formed in the population-based Rotterdam Study (RS). Results were replicated in theIntegrated Primary Care Information (IPCI) database of automated general practice data.Methods: The mean daily starting doses of metoprolol in both sexes were comparedwith independent-samples t-tests and a linear regression analysis was used to adjustin the RS for co-variables, notably, cardiovascular comorbidity, migraine, age, SBP,DBP, BMI, socioeconomic status, use of other antihypertensive drugs, smoking, andalcohol. In the IPCI-database, adjustment was for age only.Results: The mean daily starting dose was statistically significantly lower in womenthan 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 significanceremained after adjustment in both databases.Conclusions: Women received lower starting doses of metoprolol than men in twoindependent data collections despite non-sex specific cardiovascular guideline rec-ommendations. This example of real-life pharmacotherapy can lead to a form of con-founding by contraindication in pharmacoepidemiology
UR - http://www.scopus.com/inward/record.url?scp=85103412755&partnerID=8YFLogxK
U2 - 10.1002/pds.5220
DO - 10.1002/pds.5220
M3 - Article
C2 - 33675258
AN - SCOPUS:85103412755
SN - 1053-8569
VL - 30
SP - 952
EP - 959
JO - Pharmacoepidemiology and Drug Safety
JF - Pharmacoepidemiology and Drug Safety
IS - 7
ER -