Pharmacy World and Science

, Volume 27, Issue 2, pp 124–128 | Cite as

Cardiovascular drug use and differences in the incidence of cardiovascular mortality in elderly Serbian men

  • Paul Hommerson
  • Srecko I. Nedeljkovic
  • Olaf H. KlungelEmail author
  • Anthonius de Boer
  • Miodrag C. Ostojic
  • Miodrag Z. Grujic
  • Ni kola M. Vojvodic
  • Bennie P. M. Bloemberg
  • Daan Kromhout


Objective:To assess whether the difference in risk of cardiovascular mortality between urban and rural areas of Serbia could be explained by differences in the use of cardiovascular medication.

Methods: The Serbian cohorts of the Seven Countries Study, Velika Krsna (VK), Zrenjanin (ZR) and Belgrade (BG), were enrolled in 1962-1964 and were followed up for 25 years. The survivors of these cohorts were re-examined in 1987, 1988 and 1989, respectively. This second examination of elderly men aged 65 to 84 years included a questionnaire about current use of cardiovascular medication, risk factors and diseases and a physical examination. All subjects were followed until death or the predefined censor date (10 years after baseline). The Cox proportional hazards model was used to calculate the risk of cardiovascular mortality in the rural cohorts compared to the urban cohort and to adjust for confounding.

Main outcome measure: Cardiovascular death. Results: A total of 227 men from VK, 184 men from ZR and 287 men from BG were followed for a mean duration of 7.4 years and was complete for all subjects. After exclusion of 13 subjects with missing medication data, the incidences of cardiovascular mortality in VK, ZR, and BG were 60, 74, and 26 per 1000 person-years, respectively. The prevalence of cardiovascular medication use was 38% in VK, 52% in ZR, and 59% in BG. The greatest difference in use of specific medication was observed for betablockers (0% in VK and ZR, 13% in BG). After adjustment for cardiovascular risk factors, diseases and age, the relative risks (RRs) of cardiovascular mortality were 2.12 [95% CI: 1.44–3.12], and 2.27 [95% CI: 1.56–3.30] in VK, and ZR compared to BG. Additional adjustment for the use of cardiovascular medication increased these RRs to 2.40 [95% CI: 1.61–3.60] and 2.55 [95% CI: 1.72–3.78], respectively.

Conclusion:The variation in cardiovascular medication use could not explain the excess risk of mortality in the rural Serbian cohorts compared to urban Belgrade.


Antihypertensive drugs Cardiovascular drugs Cardiovascular mortality Cohort study Pharmacoepidemiology Serbia Socio-economic class 


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  1. 1.
    WHO MONICA Project1987geographic variation in mortality from cardiovascular diseases – baseline data on selected population characteristics and cardiovascular mortalityWorld Health Stat Q4017184Google Scholar
  2. 2.
    Nedeljkovic SI, Ostojic MC, Vukotic MR, Grujic MZ. Recent trends in cardiovascular disease and risk factors: Yugoslavia. In: Toshima H, Koga Y, Blackburn H, Keys A, editors. Lessons for Science from Seven Countries Study. Tokyo: Springer, 1994; 75– 91. ISBN: 3540701400.Google Scholar
  3. 3.
    Stanton, T, Reid, JL. 2001Antihypertensive drugs in the elderly – the evidence of benefitCardiovasc Drugs Ther1526973CrossRefPubMedGoogle Scholar
  4. 4.
    Deedwania, PC. 2000HypercholesterolemiaIs lipid-lowering worthwhile for older patients? Geriatrics55228Google Scholar
  5. 5.
    Perenboom, RJ, Lako, CJ, Schouten, EG. 1988Health status and medical consumption of rural and urban elderlyCompr Gerontol2124128Google Scholar
  6. 6.
    Keys, A, Aravanis, C, Blackburn, HW, Buchem, FSP, Buzina, R, Djordjevic, BS.,  et al. 1967Epidemiological studies related to coronary heart disease: characteristics of men aged 59 in seven countries.Acta Med Scand4601392Google Scholar
  7. 7.
    Anonymous. MRC. Questionnaire on respiratory symptoms. London: The Council, 1986.Google Scholar
  8. 8.
    Anonymous. MRC. Questionnaire on respiratory symptoms. Instructions to interviewers. London: The Council, 1986.Google Scholar
  9. 9.
    Rose, GA. 1962The diagnosis of ischaemic heart pain and intermittent claudication in field surveysBill WHO2764558Google Scholar
  10. 10.
    WHO MONICA Project. Manual of operations – standardization of lipid measurements. WHO/MNC/82. 2; May 1983.Google Scholar
  11. 11.
    Anonymous. Anatomical Therapeutical Chemical (ATC) classification index. Oslo: WHO Collaboration Centre for Drugs Statistics Methodology, 2000.Google Scholar
  12. 12.
    Cox, DR. 1972Regression models and lifetablesJ R Stat Soc2187220Google Scholar
  13. 13.
    Klungel, OH, Stricker, BHCh, Breteler, MMB, Seidell, JC, Psaty, BM, De Boer, A. 2001Is drug treatment of hypertension in clinical practice as effective as in randomized controlled trials with regard to the reduction of the incidence of stroke?Epidemiology1233944CrossRefPubMedGoogle Scholar
  14. 14.
    Chrischilles, EA, Foley, DJ, Wallace, RB, Lemke, JH, Semla, TP, Hanlon, JT.,  et al. 1992Use of medications by persons 65 and over: data from the established populations for epidemiologic studies of the elderlyJ Gerontol47M137M144PubMedGoogle Scholar
  15. 15.
    Rumble, RH, Morgan, K 1994Longitudinal trends in prescribing for elderly patients: two surveys four years apartBr J Gen Pract44571575PubMedGoogle Scholar
  16. 16.
    Landahl, S. 1987Drug treatment in 70-82-year-old persons A longitudinal study.Acta Med Scand22117984PubMedGoogle Scholar
  17. 17.
    Tuomilehto, J, Kuulasmaa, K, Torppa, J. 1987WHO MONICA Project: geographic variation in mortality from cardiovascular diseases. Baseline data on selected population characteristics and cardiovascular mortalityWorld Health Stat Q4017184PubMedGoogle Scholar
  18. 18.
    Fabsitz, R, Feinleib, M. 1980patterns in county mortality rates from cardiovascular diseasesAm J Epidemiol111315328PubMedGoogle Scholar
  19. 19.
    Puigpinos, R, Borrell, C, Pasarin, MI, Montella, N, Perez, G, Plasenci, A.,  et al. 2000Inequalities in mortality by social class in men in Barcelona, SpainEur J Epidemiol16751756CrossRefPubMedGoogle Scholar
  20. 20.
    Rossum, CTM, Shipley, MJ, Mheen, H, Grobbee, DE, Marmot, MG. 2000Employment grade differences in cause specific mortality A 25 year follow up of civil servants from the first Whitehall study.J Epidemiol Comm Health54178184CrossRefGoogle Scholar
  21. 21.
    Kunst, AE, Groenhof, F, Mackenbach, JP. 1998Occupational class and cause specific mortality in middle aged men in 11 European countries: comparison of population based studiesBMJ31616361642PubMedGoogle Scholar
  22. 22.
    Winkleby, MA, Jatulis, DE, Frank, E, Fortmann, SP. 1992Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular diseaseAm J Public Health8281620PubMedGoogle Scholar
  23. 23.
    Marmot, MG, Shipley, MJ. 1996Do socioeconomic differences in mortality persist after retirement? 25 Year follow up of civil servants from the first Whitehall studyBMJ31311771180PubMedGoogle Scholar
  24. 24.
    Kaplan, GA, Keil, JE. 1993Socioeconomic factors and cardiovascular disease: a review of the literatureCirculation88197398PubMedGoogle Scholar
  25. 25.
    Auchincloss, AH, Van Nostrand, JF, Ronsaville, D. 2001Access to health care for older persons in the United States: personal, structural, and neighborhood characteristicsJ Aging Health13329354PubMedGoogle Scholar
  26. 26.
    Comer, J, Mueller, K. 1995Access to health care: urban-rural comparisons from a midwestern agricultural stateJ Rural Health11128136PubMedGoogle Scholar
  27. 27.
    Saounatsou, M, Patsi, O, Fasoi, G, Stylianou, M, Kavga, A, Economou, O.,  et al. 2001The influence of the hypertensive patient’s education in compliance with their medicationPublic Health Nurs1843642CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Paul Hommerson
    • 1
  • Srecko I. Nedeljkovic
    • 2
  • Olaf H. Klungel
    • 1
    Email author
  • Anthonius de Boer
    • 1
  • Miodrag C. Ostojic
    • 2
  • Miodrag Z. Grujic
    • 2
  • Ni kola M. Vojvodic
    • 3
  • Bennie P. M. Bloemberg
    • 4
  • Daan Kromhout
    • 4
  1. 1.Department of Pharmacoepidemiology & PharmacotherapyUtrecht Institute for Pharmaceutical SciencesUtrechtThe Netherlands
  2. 2.Institute for Cardiovascular DiseasesUniversity of Belgrade Medical CenterBelgradeYugoslavia
  3. 3.Institute of GerontologyHome Care and Home TreatmentBelgradeYugoslavia
  4. 4.National Institute of Public Health and the EnvironmentBilthovenThe Netherlands

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