{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T12:30:05Z","timestamp":1764333005337,"version":"3.32.0"},"reference-count":34,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T00:00:00Z","timestamp":1616976000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["849200006"],"award-info":[{"award-number":["849200006"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Current guidelines have no sex\u2010specific dosage advice for metoprolol. To evaluate whether women and men are prescribed the same dose a cohort analysis was performed in the population\u2010based Rotterdam Study (RS). Results were replicated in the Integrated Primary Care Information (IPCI) database of automated general practice data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The mean daily starting doses of metoprolol in both sexes were compared with independent\u2010samples t\u2010tests and a linear regression analysis was used to adjust in the RS for co\u2010variables, notably, cardiovascular comorbidity, migraine, age, SBP, DBP, BMI, socioeconomic status, use of other antihypertensive drugs, smoking, and alcohol. In the IPCI\u2010database, adjustment was for age only.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean daily starting dose was statistically significantly lower in women than in men in both the RS and IPCI database, with a mean difference of 4.8 mg (95%CI \u22127.8, \u22121.8) and 4.6 mg (95%CI \u22125.3,\u20104.0), respectively. Statistical significance remained after adjustment in both databases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Women received lower starting doses of metoprolol than men in two independent data collections despite non\u2010sex specific cardiovascular guideline recommendations. This example of real\u2010life pharmacotherapy can lead to a form of confounding by contraindication in pharmacoepidemiology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.5220","type":"journal-article","created":{"date-parts":[[2021,3,6]],"date-time":"2021-03-06T11:23:30Z","timestamp":1615029810000},"page":"952-959","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Women are started on a lower daily dose of metoprolol than men irrespective of dose recommendations: <i>A potential source of confounding by contraindication in pharmacoepidemiology<\/i>"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0534-4841","authenticated-orcid":false,"given":"Linda C.","family":"Hendriksen","sequence":"first","affiliation":[{"name":"Department of Epidemiology Erasmus Medical Center  Rotterdam The Netherlands"},{"name":"Department of Clinical Pharmacy Tergooi Hospital  Hilversum The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katia M. C.","family":"Verhamme","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics Erasmus Medical Center  Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul D.","family":"Van der Linden","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy Tergooi Hospital  Hilversum The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno H.","family":"Stricker","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Erasmus Medical Center  Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loes E.","family":"Visser","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Erasmus Medical Center  Rotterdam The Netherlands"},{"name":"Department of Clinical Pharmacy Haga Teaching Hospital  The Hague The Netherlands"},{"name":"Department of Hospital Pharmacy Erasmus Medical Center  Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,3,29]]},"reference":[{"issue":"11","key":"e_1_2_9_2_1","first-page":"FC01","article-title":"Pattern of adverse drug reactions reported with cardiovascular drugs in a tertiary care teaching hospital","volume":"9","author":"Palaniappan M","year":"2015","journal-title":"J Clin Diagn Res"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.667"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1067\/mcp.2002.127111"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/PL00002226"},{"key":"e_1_2_9_6_1","unstructured":"Provider Synergies L.L.C. 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