Key result
Thiazide-associated hyponatremia in patients over 65 linked to ~29% higher MACE risk.
Why the study?
Thiazide-associated hyponatremia has been supposed to increase the risk of MACE in the elderly, but its 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
Thiazide-associated hyponatremia in elderly patients is associated with a significantly increased risk of major adverse cardiovascular events, all-cause death, and stroke, suggesting caution and monitoring when prescribing thiazides in this population.
May warrant closer 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 for MACE, 1.39 for all-cause death, and 1.61 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. (2022) conducted a cohort in Hypertension (patients prescribed thiazide diuretics) (n=4,620). Thiazide-associated hyponatremia (TAH) 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 increased the risk of major adverse cardiovascular events by 29% (HR 1.29) compared to thiazide use without hyponatremia.
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