Key result
Thiazide-associated hyponatremia in patients over 65 is linked to ~29% higher MACE risk versus normonatremia.
Why the study?
Thiazide-associated hyponatremia was suspected to increase the risk of major adverse cardiovascular events in the elderly, but the association required evaluation in elderly Taiwanese patients.
Does thiazide-associated hyponatremia increase the risk of major adverse cardiovascular events in elderly patients prescribed thiazide diuretics?
Cohort (n=4,620)
Does thiazide-associated hyponatremia increase the risk of major adverse cardiovascular events in elderly patients prescribed thiazide diuretics?
Effect estimate: HR 1.29 (95% CI 1.01-1.65)
Absolute Event Rate: 11.1% vs 7.3%
p-value: p=0.039
In elderly patients prescribed thiazide diuretics, the development of hyponatremia is associated with a significantly increased risk of major adverse cardiovascular events and all-cause mortality.
May warrant closer sodium monitoring in elderly thiazide users; leaves open whether correction reduces MACE.
BACKGROUND: Thiazide-associated hyponatremia (TAH) has been supposed to increase the risk of major adverse cardiovascular events (MACE) in the elderly. Therefore, this study aimed to evaluate the association of TAH with the risk of MACE in elderly Taiwanese patients. METHODS: Data from the longitudinal generation tracking database (LGTD 2010) of the Health and Welfare Data Science Center (HWDC) were retrospectively assessed. The TAH study group was defined as using > 30 cumulative daily defined doses (CDDDs) thiazide diuretics within one year before diagnosis of hyponatremia. The control group (1:3 propensity score matching) had no diagnosis of hyponatremia but had used > 30 CDDDs thiazide diuretics within one year. Data on MACE were extracted using International Classification of Diseases codes. Outcomes were assessed using a multivariable Cox proportional hazard model and Kaplan-Meier analysis. RESULTS: A total of 1155 and 3465 individuals were enrolled in the TAH and the control groups, respectively. The rates of MACE (11.1% vs. 7.3%) and death (22.8% vs.12.2%) were significantly higher in the TAH group than the control group. In the TAH group, the adjusted HRs were 1.29 (CI 1.01 ‒ 1.65) for MACE, 1.39 (CI 1.19 ‒ 1.63) for all-cause death, and 1.61 (CI 0.90 ‒ 2.92) for stroke. CONCLUSION: TAH in patients above 65-years-old is associated with a 29% higher risk of MACE, 39% higher risk of all-cause death, and 61% higher risk of stroke. This work suggests that thiazides prescription in elderly patients should be more careful. However, further research is required to confirm our findings.
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Yang et al. (2023) conducted a cohort in Thiazide-associated hyponatremia (n=4,620). Thiazide-associated hyponatremia vs. Thiazide use without hyponatremia was evaluated on Major adverse cardiovascular events (MACE) (HR 1.29, 95% CI 1.01-1.65, p=0.039). Thiazide-associated hyponatremia in patients over 65 years old is associated with a 29% higher risk of major adverse cardiovascular events (HR 1.29) compared to thiazide use without hyponatremia.
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