Patterns of cardiovascular drugs prescribed for an elderly Swedish population

Abstract

To the Editor,Cardiovasculardiseases(CVDs),suchascoronaryheartdisease,atri-alfibrillation,heartfailureandstroke, are increasingly commonaspeo-ple age. Therefore, cardiovascular drugs are the most frequentlyprescribed medications for preventive and therapeutic purposesamong older adults [1]. However, several factors make cardiovasculardrug treatment in elderly people complicated. Age-related pathophysi-ological changes in the cardiovascular system, liver and kidney can af-fect the pharmacokinetics and pharmacodynamics of commonly useddrugs, which makes older persons more vulnerable to adverse drugevents [2]. Additionally, most clinical trials have been conducted inyounger and healthier patient populations, leaving limited evidenceon the benefits and harms of prescribing cardiovascular drugs to frailolder patients. Indeed, cardiovascular drugs are responsible for a largeproportion of adverse drug reactions (ADRs) among older people.Therefore, monitoring cardiovascular drug therapy among older popu-lation is crucial to help reduce ADRs. A few observational studies havedescribedtheuseofspecificcardiovasculardrugs(i.e.,beta-blockers,di-uretics) among the oldest-old [3,4], but there is a lack of largepopulation-based studies that provide an assessment of a broad rangeof prescribed cardiovascular drugs within older people from a generalpopulation. In this study, we aim to investigate the patterns of use ofcardiovascular drugs with respect to age, sex and CVDs among olderpeople (≥60 years) in a Swedish cohort.DatawerefromthebaselinesurveyoftheSwedishNationalstudyonAgingandCareinKungsholmen(SNAC-K)(www.snac-k.se).TheSNAC-KwasapprovedbytheRegionalEthicalReviewBoardinStockholm,andinformed consent was obtained from all participants. The SNAC-K par-ticipants included elderly people aged ≥60 years, living either in insti-tutions or in their own homes in the Kungsholmen district in centralStockholm, Sweden [5]. The sampling was stratified into different agecohorts and years of interval for assessment, i.e., a six-year interval fortheyounger-age cohorts (60,66, 72, and 78 years)and a three-yearin-terval for the older-age cohorts (81, 84, 87, 90, 93, 96, and 99+ years).Of the 5111 persons who were initially invited for participation,4590 were alive and eligible, and 3363 (73.3%) eventually participatedin the baseline examination (March 2001–June 2004). Data onage, sex, education, lifestyle factors, medical conditions (e.g., diabetes,high cholesterol, hypertension, CVDs), and current use of medications(e.g., antihypertensive agents, lipid-lowering agents) were collectedthrough interviews by nurses and clinical examinations by physicians[5]. Information on the use of medications was further verified byinspecting drug prescriptions and containers. Heart failure, coronaryheart disease (CHD), atrial fibrillation, and stroke were considered themain CVDs. Information on history of CVDs was taken from either self-reports or the computerized inpatient register system that covers allhospitals in Sweden since 1969. Medications were classified accordingto the Anatomical Therapeutic Chemical (ATC) classification system[6]. The classes of cardiovascular drugs included antithrombotic agents(ATC code B01), cardiac therapy (C01), diuretics (C03), beta-blockers(C07), calcium channel blockers (C08), renin–angiotensin system(RAS)-acting agents (C09), and lipid-lowering drugs (C10). The crudeprevalence of drug use was standardized using the local age- and sex-specificcensusdataoftheKungsholmencommunity.Descriptivestatis-tics were performed by using IBM SPSS Statistics 22 for Windows (IBMSPSS Inc., Chicago, Illinois, USA).Ofalltheparticipants,15hadmissinginformationondruguse,leav-ing3348 peopleforthisanalysis.Themeanageofparticipantswas74.3(SD, 11.2) years, and 64.8% were women.Overall, antithrombotic agents were most commonly prescribed(26.4%), followed by diuretics (21.7%) and beta-blockers (19.2%). Theprevalence of the use of other classes of cardiovascular drugs was