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Khan A, Fahl Mar K, Gokul S, Brown WA. Mortality during US FDA clinical trials in patients with diabetes, hypertension, depression and schizophrenia. World J Biol Psychiatry 2020; 21:64-71. [PMID: 30246595 DOI: 10.1080/15622975.2018.1514465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: To evaluate the relationship between the mortality rates associated with psychiatric conditions like depression and schizophrenia compared with chronic medical conditions like hypertension and diabetes.Methods: Examined clinical trial safety data from New Drug Approval programmes reviewed by the US Food and Drug Administration and calculated all-cause and suicide/non-suicide mortality rates per 100,000 patient-exposure-years (PEY) for seven diabetes, 12 hypertension, 11 depression, and nine schizophrenia programmes (126,151 patients, 63,106.3 PEY).Results: Depression (894.8 ± 201.2) and schizophrenia (935.3 ± 214.6) had significantly higher all-cause mortality rates than diabetes (462.8 ± 70.8) and hypertension (448.4 ± 123.1). Psychiatric conditions had 1.9-2.1× the medical conditions' mortality (p < 0.001). Non-suicide mortality rates for depression (506.2 ± 151.3), schizophrenia (550.9 ± 164.7), diabetes (457.2 ± 70.4) and hypertension (430.8 ± 120.6) were comparable. Only antidiabetics showed a signal for all-cause mortality (reduction of 37%, p = 0.008).Conclusions: Depression and schizophrenia trial patients had comparable (if not higher) all-cause mortality rates as older populations in diabetes and hypertension trials, even when excluding suicides. While generalizability of the rates themselves is limited, this study can adequately estimate the relational mortality among these conditions because of the high internal consistency of clinical trials. Potential signals for mortality reduction with active treatment should be considered for all investigational medications for chronic conditions with increased mortality, including psychotropics.
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Affiliation(s)
- Arif Khan
- Northwest Clinical Research Center, Bellevue, WA, USA.,Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Walter A Brown
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
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Farah R, Zeidan RK, Chahine MN, Asmar R, Chahine R, Salameh P, Pathak A, Hosseini H. Predictors of Uncontrolled Blood Pressure in Treated Hypertensive Individuals: First Population-Based Study in Lebanon. J Clin Hypertens (Greenwich) 2016; 18:871-7. [DOI: 10.1111/jch.12775] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 11/11/2015] [Accepted: 11/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Rita Farah
- Doctoral School of Life and Health Sciences; Paris-Est University; Creteil France
- EA 4391; Excitabilité Nerveuse et Thérapeutique; Université Paris-Est; Creteil France
| | - Rouba Karen Zeidan
- Doctoral School of Biology Health and Biotechnologies; Toulouse III University; Toulouse France
| | | | - Roland Asmar
- Foundation-Medical Research Institutes; F-MRI; Beirut Lebanon
| | - Ramez Chahine
- Faculty of Medical Sciences; Lebanese University; Hadath Lebanon
| | - Pascale Salameh
- School of Pharmacy; Lebanese American University; Byblos Lebanon
- Laboratory of Clinical and Epidemiology Research; Faculty of Pharmacy; Lebanese University; Hadath Lebanon
| | - Atul Pathak
- Department of Cardiovascular Medicine, Hypertension, Risk Factors and Heart Failure Unit; Clinique Pasteur; Toulouse France
| | - Hassan Hosseini
- EA 4391; Excitabilité Nerveuse et Thérapeutique; Université Paris-Est; Creteil France
- Department of Neurology; Henri Mondor Hospital AP-HP; Creteil France
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Milane A, Abdallah J, Kanbar R, Khazen G, Ghassibe-Sabbagh M, Salloum AK, Youhanna S, Saad A, El Bayeh H, Chammas E, Platt DE, Hager J, Gauguier D, Zalloua P, Abchee A. Association of hypertension with coronary artery disease onset in the Lebanese population. SPRINGERPLUS 2014; 3:533. [PMID: 25279324 PMCID: PMC4176843 DOI: 10.1186/2193-1801-3-533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/09/2014] [Indexed: 12/22/2022]
Abstract
The onset of coronary artery disease (CAD) is influenced by cardiovascular risk factors that often occur in clusters and may build on one another. The objective of this study is to examine the relationship between hypertension and CAD age of onset in the Lebanese population. This retrospective analysis was performed on data extracted from Lebanese patients (n = 3,753). Logistic regression examined the association of hypertension with the age at CAD diagnosis after controlling for other traditional risk factors. The effect of antihypertensive drugs and lifestyle changes on the onset of CAD was also investigated. Results showed that hypertension is associated with late onset CAD (OR=0.656, 95% CI=0.504-0.853, p=0.001). Use of antihypertensive drugs showed a similar association with delayed CAD onset. When comparing age of onset in CAD patients with traditional risk factors such as hypertension, diabetes, hyperlipidemia, obesity, smoking and family history of CAD, the age of onset was significantly higher for patients with hypertension compared to those with any of the other risk factors studied (p < 0.001). In conclusion, hypertension and its treatment are associated with late coronary atherosclerotic manifestations in Lebanese population. This observation is currently under investigation to clarify its genetic and/or environmental mechanisms.
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Affiliation(s)
- Aline Milane
- Lebanese American University, School of Pharmacy, Byblos 36, Lebanon
| | - Jad Abdallah
- Lebanese American University, School of Pharmacy, Byblos 36, Lebanon
| | - Roy Kanbar
- Lebanese American University, School of Pharmacy, Byblos 36, Lebanon
| | - Georges Khazen
- School of Arts and Sciences, Lebanese American University, Byblos 36, Lebanon
| | | | | | - Sonia Youhanna
- School of Medicine, Lebanese American University, Beirut, 1102 2801 Lebanon
| | - Aline Saad
- Lebanese American University, School of Pharmacy, Byblos 36, Lebanon
| | - Hamid El Bayeh
- School of Medicine, Lebanese American University, Beirut, 1102 2801 Lebanon
| | - Elie Chammas
- School of Medicine, Lebanese American University, Beirut, 1102 2801 Lebanon
| | - Daniel E Platt
- Bioinformatics and Pattern Discovery, IBM T. J. Watson Research Centre, Yorktown Hgts, NY 10598 USA
| | - Jörg Hager
- CEA-Genomics Institute, Centre National de Génotypage, Evry, 91057 France
| | - Dominique Gauguier
- The Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Headington, Oxford, OX3 7BN UK ; INSERM UMRS872, Centre de Recherche des Cordeliers, 15 Rue de l'école de Médecine, Paris, 75006 France
| | - Pierre Zalloua
- School of Medicine, Lebanese American University, Beirut, 1102 2801 Lebanon ; Harvard School of Public Health, Boston, MA 02215 USA
| | - Antoine Abchee
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Herttua K, Tabák AG, Martikainen P, Vahtera J, Kivimäki M. Adherence to antihypertensive therapy prior to the first presentation of stroke in hypertensive adults: population-based study. Eur Heart J 2013; 34:2933-9. [PMID: 23861328 PMCID: PMC3791393 DOI: 10.1093/eurheartj/eht219] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 04/29/2013] [Accepted: 05/27/2013] [Indexed: 01/01/2023] Open
Abstract
AIMS Antihypertensive drug therapy is a major strategy of stroke prevention among hypertensive patients. The aim of this study was to estimate the excess risk of stroke associated with non-adherence to antihypertensive drug therapy among hypertensive patients. METHODS AND RESULTS We conducted a population-based study using records from Finnish national registers for 1 January 1995 to 31 December 2007. Of the 73 527 hypertensive patients aged 30 years or older and without pre-existing stroke or cardiovascular disease, 2144 died from stroke and 24 560 were hospitalized due to stroke during the follow-up. At the 2- and 10-year follow-up after the start of continuous antihypertensive medication, non-adherent patients had 3.81 [95% confidence interval (CI) 2.85-5.10] and 3.01 (95% CI: 2.37-3.83) times higher odds of stroke death when compared with the adherent patients. The corresponding odds ratio (OR) for stroke hospitalization was 2.74 (95% CI: 2.35-3.20) at Year 2 and 1.71 (95% CI: 1.49-1.96) at Year 10. In the stroke-event year, the ORs were higher, 5.68 (95% CI: 5.05-6.39) for stroke death and 1.87 (95% CI: 1.72-2.03) for hospitalization. Among those using agents acting on the renin-angiotensin system combined with diuretics or β-blockers, these ORs were 7.49 (95% CI: 5.62-9.98) and 3.91 (95% CI: 3.23-4.75), respectively. The associations between non-adherence and stroke followed a dose-response pattern--the poorer the adherence, the greater the risk of death and hospitalization due to stroke. CONCLUSION These data suggest that poor adherence to antihypertensive therapy substantially increases near- and long-term risk of stroke among hypertensive patients.
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Affiliation(s)
- Kimmo Herttua
- Population Research Unit, Department of Social Research, University of Helsinki, Unioninkatu 38, PO Box 59, 00014Helsinki, Finland
| | - Adam G. Tabák
- Department of Epidemiology and Public Health, University College London, London, UK
- 1st Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Pekka Martikainen
- Population Research Unit, Department of Social Research, University of Helsinki, Unioninkatu 38, PO Box 59, 00014Helsinki, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
- Department of Behavioral Sciences, University of Helsinki, Helsinki, Finland
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