In the western world, cardiovascular disease is the leading cause of death for both sexes. These ... more In the western world, cardiovascular disease is the leading cause of death for both sexes. These diseases show substantial differences between the sexes with respect to epidemiology, biology and clinical aspects. In recent years, more attention has been directed towards sex differences in pharmacological effects. Although both sexes are included in most pharmacological trials, the proportion of women is often too low to enable sex-specific analyses.
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 25, 2010
In the western world, cardiovascular disease is the leading cause of death for both sexes. These ... more In the western world, cardiovascular disease is the leading cause of death for both sexes. These diseases show substantial differences between the sexes with respect to epidemiology, biology and clinical aspects. In recent years, more attention has been directed towards sex differences in pharmacological effects. Although both sexes are included in most pharmacological trials, the proportion of women is often too low to enable sex-specific analyses.
Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy, 2002
To investigate the prescription pattern for cardiovascular drugs among patients discharged after ... more To investigate the prescription pattern for cardiovascular drugs among patients discharged after an acute myocardial infarction (AMI) in hospitals that had participated in a corresponding study seven years earlier, and examine what the indications were for use of the different drugs. From 16 hospitals we drew a sample of patients who were discharged with a diagnosis of AMI during a three months period in 1999/2000. Physicians in each hospital obtained from the medical records the observed rate of use of cardiovascular drugs at discharge. The drug use was compared with findings from a corresponding sample drawn in 1993. The main indication for use of the different cardiovascular drugs was recorded for the 1999/2000 sample. 399 patients discharged alive were included in the first study and 767 in the second. The use of beta-blockers, ACE inhibitors and statins rose substantially during the period. For patients aged </=70 drug use in respectively 1993 and 1999/2000 was as follows: b...
To investigate to what extent and by what methods clinicians assess left ventricular (LV) functio... more To investigate to what extent and by what methods clinicians assess left ventricular (LV) function after an acute myocardial infarction (AMI) and how the results of the assessments relate to the use of angiotensin-converting enzyme (ACE) inhibitors; furthermore, to explore which main indications caused the clinicians to initiate ACE inhibitor therapy. From 16 hospitals we drew a sample of patients who were discharged with the diagnosis of AMI during a 3-month period in 1999/2000. Physicians in each hospital obtained the observed rate of use of cardiovascular drugs at discharge and also information on ejection fraction (EF) measurements. The results of the EF recordings were classified into three categories: &amp;amp;amp;amp;gt;0.50, 0.40-0.50 and &amp;amp;amp;amp;lt;0.40. The clinicians&amp;amp;amp;amp;#39; main indications for drug use were reported. Among 767 patients discharged alive, EF was measured in 409 (53%), by echocardiography in 53% and by radionuclide ventriculography in 47%. Of the 409 patients 227 (55%) had EF &amp;amp;amp;amp;gt;0.50, 95 (24%) EF 0.40-0.50 and 87 (21%) EF &amp;amp;amp;amp;lt;0.40. Adjusted odds ratio for ACE inhibitor therapy being initiated during the AMI was 13.5 for those with EF &amp;amp;amp;amp;lt;0.40 compared with those with EF &amp;amp;amp;amp;gt;0.50. The main indication for starting ACE inhibitor therapy was heart failure (50%) followed by secondary prevention (42%). Measuring EF appears to be an important tool in the evaluation of AMI patients prior to discharge from hospital. Initiation of ACE inhibitor therapy related strongly to the results of the assessments.
It has not been decided to what extent the results from statin trials should be transferred to cl... more It has not been decided to what extent the results from statin trials should be transferred to clinical practice in the very old. The aim of the study was to assess the use of cardiovascular drugs after an acute myocardial infarction (MI), with particular focus on statins, in very old patients as compared to younger patients. A sample of 901 acute MI patients was drawn from 16 hospitals in 1999/2000; the patients were followed up for 2.5 years. Information on demographic variables and drug therapy was obtained from hospital records, and in the follow-up period by direct patient contact or questionnaire. The main indications for prescribing the various cardiovascular drugs were recorded. At discharge, drug use in patients &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=80 and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;80 years, respectively, was as follows: ACE-inhibitors 48 versus 32%, nitrates 55 versus 32%, diuretics 64 versus 26%, aspirin 72 versus 86%, and beta-blockers 67 versus 85%. A striking difference was found for statins: 9% in the very old and 72% in younger patients. The pattern of drug use generally remained unchanged after 2.5 years. Survival rates for patients &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=80 and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;80 years: at discharge 72 versus 90%, after 2.5 years 34 versus 73%. Drug therapy was widely accepted for the indication secondary prevention after MI in patients above 80 years of age. The various cardiovascular drugs were prescribed to about the same extent for very old and younger patients. The exception was lipid lowering drugs which, despite the physicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; recognition of the indication secondary prevention in the very old patients, were prescribed to a limited extent.
Several studies, which have compared the efficacy of conventional antihypertensive drugs (thiazid... more Several studies, which have compared the efficacy of conventional antihypertensive drugs (thiazide diuretics and beta-blockers) with the newer agents [calcium blockers and angiotensin-converting enzyme (ACE) inhibitors], have shown that they are almost equally efficacious with regard to effects on blood pressure, and in preventing cardiovascular morbidity and mortality. The potential value of these drugs when hypertensive patients suffer an acute myocardial infarction (AMI) has, however, not been fully elucidated. The objective of the present observational study was to investigate whether prior use of different antihypertensive drugs could modify or influence in-hospital death in hypertensives suffering an AMI. A total of 299 hypertensive patients with the diagnosis of AMI were included. The demographic data were obtained from medical records. Variables were entered into a logistic regression model. The main predictors of death were age (adjusted odds ratio (ORa) 1.07, p = 0.002 (per each year), and the use of diuretics (ORa 2.54, p = 0.018) and calcium blockers (ORa 2.54, p = 0.010). On the other hand, the use of ACE inhibitors was associated with a marked reduction of in-hospital death (ORa 0.44, p = 0.045). The present study indicates that while the use of ACE inhibitors was associated with a reduced risk of in-hospital death in hypertensive patients suffering an AMI, the use of diuretics and calcium blockers was associated with increased risks.
More than 50 Norwegian public and private laboratories provide one or more analyses for therapeut... more More than 50 Norwegian public and private laboratories provide one or more analyses for therapeutic drug monitoring or testing for drugs of abuse. Practices differ among laboratories, and analytical repertoires can change rapidly as new substances become available for analysis. The Pharmacology Portal was developed to provide an overview of these activities and to standardize the practices and terminology among laboratories. The Pharmacology Portal is a modern dynamic web database comprising all available analyses within therapeutic drug monitoring and testing for drugs of abuse in Norway. Content can be retrieved by using the search engine or by scrolling through substance lists. The core content is a substance registry updated by a national editorial board of experts within the field of clinical pharmacology. This ensures quality and consistency regarding substance terminologies and classification. All laboratories publish their own repertoires in a user-friendly workflow, adding laboratory-specific details to the core information in the substance registry. The user management system ensures that laboratories are restricted from editing content in the database core or in repertoires within other laboratory subpages. The portal is for nonprofit use, and has been fully funded by the Norwegian Medical Association, the Norwegian Society of Clinical Pharmacology, and the 8 largest pharmacologic institutions in Norway. The database server runs an open-source content management system that ensures flexibility with respect to further development projects, including the potential expansion of the Pharmacology Portal to other countries.
In the western world, cardiovascular disease is the leading cause of death for both sexes. These ... more In the western world, cardiovascular disease is the leading cause of death for both sexes. These diseases show substantial differences between the sexes with respect to epidemiology, biology and clinical aspects. In recent years, more attention has been directed towards sex differences in pharmacological effects. Although both sexes are included in most pharmacological trials, the proportion of women is often too low to enable sex-specific analyses.
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 25, 2010
In the western world, cardiovascular disease is the leading cause of death for both sexes. These ... more In the western world, cardiovascular disease is the leading cause of death for both sexes. These diseases show substantial differences between the sexes with respect to epidemiology, biology and clinical aspects. In recent years, more attention has been directed towards sex differences in pharmacological effects. Although both sexes are included in most pharmacological trials, the proportion of women is often too low to enable sex-specific analyses.
Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy, 2002
To investigate the prescription pattern for cardiovascular drugs among patients discharged after ... more To investigate the prescription pattern for cardiovascular drugs among patients discharged after an acute myocardial infarction (AMI) in hospitals that had participated in a corresponding study seven years earlier, and examine what the indications were for use of the different drugs. From 16 hospitals we drew a sample of patients who were discharged with a diagnosis of AMI during a three months period in 1999/2000. Physicians in each hospital obtained from the medical records the observed rate of use of cardiovascular drugs at discharge. The drug use was compared with findings from a corresponding sample drawn in 1993. The main indication for use of the different cardiovascular drugs was recorded for the 1999/2000 sample. 399 patients discharged alive were included in the first study and 767 in the second. The use of beta-blockers, ACE inhibitors and statins rose substantially during the period. For patients aged </=70 drug use in respectively 1993 and 1999/2000 was as follows: b...
To investigate to what extent and by what methods clinicians assess left ventricular (LV) functio... more To investigate to what extent and by what methods clinicians assess left ventricular (LV) function after an acute myocardial infarction (AMI) and how the results of the assessments relate to the use of angiotensin-converting enzyme (ACE) inhibitors; furthermore, to explore which main indications caused the clinicians to initiate ACE inhibitor therapy. From 16 hospitals we drew a sample of patients who were discharged with the diagnosis of AMI during a 3-month period in 1999/2000. Physicians in each hospital obtained the observed rate of use of cardiovascular drugs at discharge and also information on ejection fraction (EF) measurements. The results of the EF recordings were classified into three categories: &amp;amp;amp;amp;gt;0.50, 0.40-0.50 and &amp;amp;amp;amp;lt;0.40. The clinicians&amp;amp;amp;amp;#39; main indications for drug use were reported. Among 767 patients discharged alive, EF was measured in 409 (53%), by echocardiography in 53% and by radionuclide ventriculography in 47%. Of the 409 patients 227 (55%) had EF &amp;amp;amp;amp;gt;0.50, 95 (24%) EF 0.40-0.50 and 87 (21%) EF &amp;amp;amp;amp;lt;0.40. Adjusted odds ratio for ACE inhibitor therapy being initiated during the AMI was 13.5 for those with EF &amp;amp;amp;amp;lt;0.40 compared with those with EF &amp;amp;amp;amp;gt;0.50. The main indication for starting ACE inhibitor therapy was heart failure (50%) followed by secondary prevention (42%). Measuring EF appears to be an important tool in the evaluation of AMI patients prior to discharge from hospital. Initiation of ACE inhibitor therapy related strongly to the results of the assessments.
It has not been decided to what extent the results from statin trials should be transferred to cl... more It has not been decided to what extent the results from statin trials should be transferred to clinical practice in the very old. The aim of the study was to assess the use of cardiovascular drugs after an acute myocardial infarction (MI), with particular focus on statins, in very old patients as compared to younger patients. A sample of 901 acute MI patients was drawn from 16 hospitals in 1999/2000; the patients were followed up for 2.5 years. Information on demographic variables and drug therapy was obtained from hospital records, and in the follow-up period by direct patient contact or questionnaire. The main indications for prescribing the various cardiovascular drugs were recorded. At discharge, drug use in patients &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=80 and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;80 years, respectively, was as follows: ACE-inhibitors 48 versus 32%, nitrates 55 versus 32%, diuretics 64 versus 26%, aspirin 72 versus 86%, and beta-blockers 67 versus 85%. A striking difference was found for statins: 9% in the very old and 72% in younger patients. The pattern of drug use generally remained unchanged after 2.5 years. Survival rates for patients &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=80 and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;80 years: at discharge 72 versus 90%, after 2.5 years 34 versus 73%. Drug therapy was widely accepted for the indication secondary prevention after MI in patients above 80 years of age. The various cardiovascular drugs were prescribed to about the same extent for very old and younger patients. The exception was lipid lowering drugs which, despite the physicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; recognition of the indication secondary prevention in the very old patients, were prescribed to a limited extent.
Several studies, which have compared the efficacy of conventional antihypertensive drugs (thiazid... more Several studies, which have compared the efficacy of conventional antihypertensive drugs (thiazide diuretics and beta-blockers) with the newer agents [calcium blockers and angiotensin-converting enzyme (ACE) inhibitors], have shown that they are almost equally efficacious with regard to effects on blood pressure, and in preventing cardiovascular morbidity and mortality. The potential value of these drugs when hypertensive patients suffer an acute myocardial infarction (AMI) has, however, not been fully elucidated. The objective of the present observational study was to investigate whether prior use of different antihypertensive drugs could modify or influence in-hospital death in hypertensives suffering an AMI. A total of 299 hypertensive patients with the diagnosis of AMI were included. The demographic data were obtained from medical records. Variables were entered into a logistic regression model. The main predictors of death were age (adjusted odds ratio (ORa) 1.07, p = 0.002 (per each year), and the use of diuretics (ORa 2.54, p = 0.018) and calcium blockers (ORa 2.54, p = 0.010). On the other hand, the use of ACE inhibitors was associated with a marked reduction of in-hospital death (ORa 0.44, p = 0.045). The present study indicates that while the use of ACE inhibitors was associated with a reduced risk of in-hospital death in hypertensive patients suffering an AMI, the use of diuretics and calcium blockers was associated with increased risks.
More than 50 Norwegian public and private laboratories provide one or more analyses for therapeut... more More than 50 Norwegian public and private laboratories provide one or more analyses for therapeutic drug monitoring or testing for drugs of abuse. Practices differ among laboratories, and analytical repertoires can change rapidly as new substances become available for analysis. The Pharmacology Portal was developed to provide an overview of these activities and to standardize the practices and terminology among laboratories. The Pharmacology Portal is a modern dynamic web database comprising all available analyses within therapeutic drug monitoring and testing for drugs of abuse in Norway. Content can be retrieved by using the search engine or by scrolling through substance lists. The core content is a substance registry updated by a national editorial board of experts within the field of clinical pharmacology. This ensures quality and consistency regarding substance terminologies and classification. All laboratories publish their own repertoires in a user-friendly workflow, adding laboratory-specific details to the core information in the substance registry. The user management system ensures that laboratories are restricted from editing content in the database core or in repertoires within other laboratory subpages. The portal is for nonprofit use, and has been fully funded by the Norwegian Medical Association, the Norwegian Society of Clinical Pharmacology, and the 8 largest pharmacologic institutions in Norway. The database server runs an open-source content management system that ensures flexibility with respect to further development projects, including the potential expansion of the Pharmacology Portal to other countries.
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