{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T02:07:40Z","timestamp":1778551660054,"version":"3.51.4"},"reference-count":38,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2016,10,18]]},"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Healthy user bias arises when users of preventive medications such as lipid-lowering drugs (LLDs), hormone replacement therapy and antihypertensive (AH) medications are healthier than non-users due to factors other than medication effects, making the medications appear more beneficial in observational studies of effectiveness and safety. The purpose of the study is to examine factors contributing to healthy user effect in patients taking AHs or LLDs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Among patients with hypertension or hyperlipidaemia in a population-based sample from the National Health and Nutrition Examination Survey (1999\u20132010), we assessed the association between socioeconomic and lifestyle factors and the use of AHs\/LLDs by logistic regression with adjustment for demographics and comorbidities in a cross-sectional study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>When 9715 AH\/LLD users were compared with 3725 non-users, AH\/LLD users were more likely to be: highly educated (OR 1.2, 95% CI 1.2 to 1.3), non-impoverished (OR 1.3, 95% CI 1.2 to 1.4), current non-smokers (OR 1.2, 95% CI 1.1 to 1.4), physically active (OR 1.1, 95% CI 1.0 to 1.2) and consume more calcium (OR 1.1, 95% CI 1.0 to 1.3) but less likely to have normal body mass index (OR 0.6, 95% CI 0.6 to 0.7) or to meet dietary sodium recommendations (OR 0.8, 95% CI 0.7 to 0.9).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We identified several salutary lifestyle factors associated with AH\/LLD use in a representative US population. Healthy user effect may be partly explained by better socioeconomic profiles and lifestyles in AH\/LLD users compared with non-users.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2016-000417","type":"journal-article","created":{"date-parts":[[2017,3,10]],"date-time":"2017-03-10T20:10:11Z","timestamp":1489176611000},"page":"e000417","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Potential contribution of lifestyle and socioeconomic factors to healthy user bias in antihypertensives and lipid-lowering drugs"],"prefix":"10.1136","volume":"4","author":[{"given":"Mitsuyo","family":"Kinjo","sequence":"first","affiliation":[{"name":"Department of Medicine, Rheumatology, Okinawa Chubu Hospital, Uruma, Okinawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"Chia-Cheng Lai","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maarit Jaana","family":"Korhonen","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita L","family":"McGill","sequence":"additional","affiliation":[{"name":"Department of Medicine, Nephrology, The University of Chicago, Chicago, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soko","family":"Setoguchi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rutgers School of Public Health, New Brunswick, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,3,9]]},"reference":[{"key":"2025081709430154000_4.1.e000417.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.192640"},{"key":"2025081709430154000_4.1.e000417.2","first-page":"CD001841","article-title":"First-line drugs for hypertension","volume":"8","author":"Wright","year":"2009","journal-title":"Cochrane Database of Syst Rev"},{"key":"2025081709430154000_4.1.e000417.3","first-page":"CD004816","article-title":"Statins for the primary prevention of cardiovascular disease","volume":"1","author":"Taylor","year":"2013","journal-title":"Cochrane Database of Syst Rev"},{"key":"2025081709430154000_4.1.e000417.4","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-011-0221-2"},{"key":"2025081709430154000_4.1.e000417.5","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1P150"},{"key":"2025081709430154000_4.1.e000417.6","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.10.1147"},{"key":"2025081709430154000_4.1.e000417.7","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-200111000-00017"},{"key":"2025081709430154000_4.1.e000417.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39548.738368.BE"},{"key":"2025081709430154000_4.1.e000417.9","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.830299"},{"key":"2025081709430154000_4.1.e000417.10","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2011.223289"},{"key":"2025081709430154000_4.1.e000417.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g2866"},{"key":"2025081709430154000_4.1.e000417.12","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwm070"},{"key":"2025081709430154000_4.1.e000417.13","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.176158"},{"key":"2025081709430154000_4.1.e000417.14","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.621417"},{"key":"2025081709430154000_4.1.e000417.15","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.103234"},{"key":"2025081709430154000_4.1.e000417.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2010.04.013"},{"key":"2025081709430154000_4.1.e000417.17","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000437738.63853.7a"},{"key":"2025081709430154000_4.1.e000417.18","unstructured":"Kuczmarski RJ , Ogden CL , Guo SS , et al . 2000 CDC growth charts for the United States: methods and development. Vital and health stat 11 2002:1\u2013190."},{"key":"2025081709430154000_4.1.e000417.19","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-199601000-00014"},{"key":"2025081709430154000_4.1.e000417.20","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2007.119"},{"key":"2025081709430154000_4.1.e000417.21","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.111270"},{"key":"2025081709430154000_4.1.e000417.22","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2006.055525"},{"key":"2025081709430154000_4.1.e000417.23","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2008.03360.x"},{"key":"2025081709430154000_4.1.e000417.24","doi-asserted-by":"publisher","DOI":"10.1007\/s12160-010-9212-6"},{"key":"2025081709430154000_4.1.e000417.25","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2710.2000.00315.x"},{"key":"2025081709430154000_4.1.e000417.26","first-page":"2144","article-title":"Family practice patients' adherence to statin medications","volume":"53","author":"Natarajan","year":"2007","journal-title":"Can Fam Physician"},{"key":"2025081709430154000_4.1.e000417.27","doi-asserted-by":"publisher","DOI":"10.1002\/pds.2042"},{"key":"2025081709430154000_4.1.e000417.28","first-page":"e133","article-title":"Primary nonadherence to statin therapy: patients' perceptions","volume":"19","author":"Harrison","year":"2013","journal-title":"Am J Manag Care"},{"key":"2025081709430154000_4.1.e000417.29","doi-asserted-by":"publisher","DOI":"10.1007\/s11883-012-0291-7"},{"key":"2025081709430154000_4.1.e000417.30","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-014-9425-z"},{"key":"2025081709430154000_4.1.e000417.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2015.02.008"},{"key":"2025081709430154000_4.1.e000417.32","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-2413"},{"key":"2025081709430154000_4.1.e000417.33","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/1475-2840-8-25","article-title":"Patterns and predictors of statin prescription in patients with type 2 diabetes","volume":"8","author":"Berthold","year":"2009","journal-title":"Cardiovasc Diabetol"},{"key":"2025081709430154000_4.1.e000417.34","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1186\/1475-2840-11-120","article-title":"Personal attributes that influence the adequate management of hypertension and dyslipidemia in patients with type 2 diabetes. Results from the DIAB-CORE Cooperation","volume":"11","author":"R\u00fcckert","year":"2012","journal-title":"Cardiovasc Diabetol"},{"key":"2025081709430154000_4.1.e000417.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2007.06.019"},{"key":"2025081709430154000_4.1.e000417.36","doi-asserted-by":"publisher","DOI":"10.1038\/ajh.2012.30"},{"key":"2025081709430154000_4.1.e000417.37","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1097\/SMJ.0000000000000013","article-title":"Effect of patients' awareness of CVD risk factors on health-related behaviors","volume":"106","author":"Alzaman","year":"2013","journal-title":"South Med J"},{"key":"2025081709430154000_4.1.e000417.38","doi-asserted-by":"publisher","DOI":"10.1038\/oby.2007.372"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2016-000417","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T16:43:10Z","timestamp":1755448990000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2016-000417"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,3]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2017,3,9]]},"published-print":{"date-parts":[[2017,3]]}},"alternative-id":["10.1136\/openhrt-2016-000417"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2016-000417","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,3]]}}}