- Title
- Cardiovascular medication use and health-related quality of life in older women with diabetes
- Creator
- Hikmayani, Nur Hafidha
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2008
- Description
- Masters Research - Master of Clinical Epidemiology (MCE)
- Description
- Background: Diabetic patients are at high risk for cardiovascular disease. Evidence and guidelines supporting the use of multiple cardiovascular medications to manage diabetes have been well-established. It is suggested that the benefits conferred by combination of the drugs are potentially offset by perceived deterioration on health-related quality of life. Aims and Objectives: A cross-sectional study was conducted to determine the extent of use of cardiovascular medications in elderly Australian women with diabetes, either individually or in combination, and to examine whether usage patterns of cardiovascular medications have effects on their health-related quality of life. METHODS. A subset of the older cohort completing Survey 4 in the Australian Longitudinal Study on Women’s Health (ALSWH) who self-reported to have been diagnosed with diabetes and/or use medications indicative of diabetes were selected as study subjects. Use of cardiovascular medications was identified from self-reports on usage of medications belonging to the ATC code B01AC (platelet aggregation inhibitors), C03 (diuretics), C07 (β-blockers), C08 (calcium channel blockers), C09 (agents acting on the renin-angiotensin system), C02 (other antihypertensives) and C10 (lipid modifying agents). Patterns of cardiovascular drug use were classified as no use, using any antihypertensives, lipid lowering agents or antiplatelet drugs, using any two combinations and using all the three classes of medications. Quality of life was measured with the use of the SF-36, focusing on the physical functioning, general health, vitality and mental health subscales. The extent of medication use was summarised as prevalence. Linear regression analyses of survey data evaluated the associations between usage patterns of cardiovascular medication and individual subscales of the SF-36 while controlling for other sociodemographic, health behaviour and health service utilisation characteristics. Results: Prevalences of use of any cardiovascular medication were generally high (nearly 90%). Twenty-three percent of elderly women used any one category of antihypertensives, lipid lowering drugs or antiplatelets, 37.5% reported use of a combination of any two and 29.1% were on all three categories of medicines. Using at least one cardiovacular drug was shown to be associated with higher QoL scores. After adjustment for other covariates, being on triple combination of cardiovascular drugs was significantly associated with increased scores on physical functioning (coefficient 16.134, 95% CI 6.940, 25.327), general health (10.058, 95% CI 2.649, 17.468) and mental health subscales (12.896, 95% CI 6.562, 15.882). Being on any dual combination was significantly associated with increased scores on physical functioning (coefficient 14.744, 95% CI 5.988, 23.501) and general health (8.334, 95% CI 1.200, 15.467), whereas using single a cardiovascular drug is only significantly associated with increased score on physical functioning (coefficient 12.346, 95% CI 3.943, 20.750). A negative association was found between using three cardiovascular drugs and vitality score, albeit modest and statistically non-significant (coefficient -1.342, 95% CI -7.927, 5.242). Conclusion: The use of cardiovascular medications in elderly Australian women with diabetes was reasonably high particularly for the secondary prevention of cardiovascular disease. Use of multiple cardiovascular drugs was demonstrated to be subjectively beneficial in terms of perceived physical functioning, general health and mental health. There remains a possibility that being on more intensive regimens with more cardiovascular drugs will diminish patients’ QoL since the remaining subscales of the SF-36 were not evaluated. If HRQoL in diabetics is to be more comprehensively assessed, there may be value in employing a diabetes-specific instrument as an add-on to the generic QoL instrument.
- Subject
- diabetes; HRQOL; quality of life; women's health; SF-36; cardiovascular medication; elderly; ALSWH
- Identifier
- http://hdl.handle.net/1959.13/1520036
- Identifier
- uon:57437
- Rights
- Copyright 2008 Nur Hafidha Hikmayani
- Language
- eng
- Full Text
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| View Details Download | ATTACHMENT01 | Thesis | 805 KB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 203 KB | Adobe Acrobat PDF | View Details Download |