Hallas J, Margulis AV, Pottegard A, Kristiansen N, Bui CL, Krueger W, Atsma WJ, Appenteng K, Franks B, de Vogel S, D 'Silva M, Perez-Gutthann S, Arana A. Incidence of cardiovascular events in new users of overactive bladder medications in Denmark. Poster presented at the 32nd ICPE International Conference on Pharmacoepidemiology & Therapeutic Risk Management; August 28, 2016. Dublin, Ireland. [abstract] Pharmacoepidemiol Drug Saf. 2016 Aug; 25(Suppl 3):491.

BACKGROUND: A higher prevalence of cardiovascular comorbidities has been reported in users of antimuscarinic overactive bladder (OAB) medications.

OBJECTIVES: We investigated whether the incidence rate of acute myocardial infarction (AMI), stroke, cardiovascular mortality, and all-cause mortality differed comparing users of six different OAB drugs. A composite endpoint, major adverse cardiac events (MACE)—nonfatal AMI, nonfatal stroke, or cardiovascular mortality—was also examined.

METHODS: Using the Danish national registries, we identified a cohort of new users of oxybutynin, tolterodine, solifenacin, fesoterodine, trospium, or darifenacin, aged greater than or equal to 18 years, 2004-2012. Follow-up ended with event diagnosis, death, disenrollment, or end of study period. Exposure to OAB drugs was ascertained from the Danish National Prescription Registry; outcomes were ascertained from the Danish National Registry of Patients. We calculated crude and age-sex–standardized incidence rates (SIR). Regression models were used to estimate multivariable adjusted incidence rate ratios (IRR) and 95% confidence intervals for cardiovascular endpoints with reference to current exposure to other OAB drugs. In addition, 12 different propensity score models were constructed representing exposure propensity at cohort entry (six different sets of comparators, for both current and recent use).

RESULTS: The study population included 72,917 patients; 60% female; mean age at cohort entry, 66 years. For current use of any OAB drug, the SIR per 1,000 person-years was 2.7 (2.5-2.9) for AMI, 1.3 (1.2-1.5) for stroke, 15.2 (14.8-15.6) for allcause mortality, and 7.8 (7.5-8.1) for MACE. We did not observe differences in risk between any of the cardiovascular endpoints for any of the individual OAB drugs with the age-sex-adjusted IRRs or in the multivariate analyses: IRRs comparing each individual drug with the other OAB drugs pooled were generally around 1. The same pattern was observed when adjustment was performed with propensity scores.

CONCLUSIONS: The risk of the targeted cardiovascular endpoints was similar among individual OAB medications studied.