Comparison of cardiovascular events among treatments for overactive bladder: a Danish nationwide cohort study

Eur J Clin Pharmacol. 2018 Feb;74(2):193-199. doi: 10.1007/s00228-017-2359-3. Epub 2017 Nov 13.


Purpose: The purpose of this study is to explore the cardiovascular safety of antimuscarinic drugs to treat overactive bladder (OAB) in Denmark.

Methods: This was a cohort study using data recorded in Danish registries from patients newly exposed to darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, or trospium in 2004-2012. We estimated crude and standardized incidence rates (IRs) for acute myocardial infarction (AMI); stroke; cardiovascular mortality; major adverse cardiac events (MACE, a combined endpoint of the previous three outcomes); and all-cause death for the individual and combined drugs. We also estimated crude, standardized, and propensity score-stratified incidence rate ratios (IRRs) comparing individual antimuscarinic drugs to tolterodine as the reference.

Results: Among 72,917 new users of OAB drugs (mean age, 66 years; 60% women), the standardized IR (95% confidence interval) per 1000 person-years for current use of any OAB drug was 2.7 (2.5-2.9) for AMI, 1.3 (1.2-1.5) for stroke, 7.8 (7.5-8.1) for MACE, 4.8 (4.5-5.0) for cardiovascular mortality, and 15.2 (14.8-15.6) for all-cause mortality. Propensity score-stratified IRRs for current use (reference, tolterodine) were close to the null for all drugs and endpoints.

Conclusions: We did not identify differences in the risk of cardiovascular events or mortality among users of individual antimuscarinic OAB drugs.

Keywords: Cardiovascular diseases; Denmark; Muscarinic antagonists; Pharmacoepidemiology; Urinary bladder, overactive.

MeSH terms

  • Aged
  • Cardiovascular Diseases / chemically induced*
  • Cardiovascular Diseases / epidemiology*
  • Denmark / epidemiology
  • Female
  • Humans
  • Incidence
  • Male
  • Muscarinic Antagonists / adverse effects*
  • Urinary Bladder, Overactive / drug therapy


  • Muscarinic Antagonists