December 1, 1993JAMA
Female gender as a risk factor for torsades de pointes associated with cardiovascular drugs
Key result
Women constituted 70% (95% CI, 64% to 75%) of reported cases of torsades de pointes associated with cardiovascular drugs, representing a significantly greater prevalence than expected (P<0.05).
Why the study?
Does female gender increase the risk of torsades de pointes associated with cardiovascular drugs?
Population
332 patients from 93 articles with reported cases of polymorphic ventricular tachycardia associated with…
Comparison
Cardiovascular drugs that prolong cardiac… vs Expected female prevalence estimated from…
Design
Systematic_review
Authors
Discussion
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Implication
May warrant closer monitoring for torsades in women on cardiovascular drugs; confirms female predominance and extends sex-specific risk data.
Key Points
- To test the hypothesis that women are overrepresented among cases of torsades de pointes linked to cardiovascular drugs.
- MEDLINE literature review from 1980 to 1992 investigating torsades de pointes incidents.
- Ninety-three articles identified with gender-specified cases involving various cardiovascular drugs.
- Analysis included 332 identified cases with a QTc interval threshold of 0.45 seconds or greater.
- Women constituted 70% (95% CI, 64%-75%) of torsades de pointes cases, exceeding expected female prevalence.
- Female prevalence exceeded 50% in 83% of studies with at least four cases.
- Statistically significant gender differences were noted for all cardiovascular drugs except procainamide (P < .05).
Study Design
Type
Systematic Review (n=332)
Structured PICO
Does female gender increase the risk of torsades de pointes associated with cardiovascular drugs?
P
Population
332 patients from 93 articles with reported cases of polymorphic ventricular tachycardia (torsades de pointes) associated with cardiovascular drugs, with QTc interval ≥0.45 seconds.
I
Intervention
Cardiovascular drugs that prolong cardiac repolarization (quinidine, procainamide, disopyramide, amiodarone, sotalol, bepridil, prenylamine)
C
Comparator
Expected female prevalence estimated from antiarrhythmic drug prescription data or assumed ≤50%
O
Outcome
Female prevalence among reported cases of torsades de pointessafety
Main Result
p-value: p=< .05
Women are significantly more prone than men to develop torsades de pointes when treated with cardiovascular drugs that prolong cardiac repolarization.
Cite This Study
Raj Makkar (1993) conducted a systematic review in Torsades de pointes associated with cardiovascular drugs (n=332). Cardiovascular drugs that prolong cardiac repolarization vs. Expected female prevalence based on prescription data or male-predominant conditions was evaluated on Female prevalence among reported cases of torsades de pointes (95% CI 64% to 75%, p=< .05). Women constituted 70% (95% CI, 64% to 75%) of reported cases of torsades de pointes associated with cardiovascular drugs, representing a significantly greater prevalence than expected (P<0.05).