Cardiovascular use and health-related Quality of Life in older women with diabetes Candidate: Nur Ha#dha Hikmayani Degree: Master of Clinical Epidemiology University: School of Medicine and Public Health, University of Newcastle Supervisors: Dr Jane Robertson (School of Medicine and Public Health, University of Newcastle) & Ms Xenia Dolja-Gore (Research Centre for Gender, Health and Ageing, University of Newcastle) Background. Diabetes patients are at high risk for was determined by presence of macrovascular disease cardiovascular disease. Evidence and guidelines identi#ed from self-reports of having at least one of recommending the use of multiple cardiovascular the following conditions: stroke, disease (angina, to support the management of diabetes heart attack, other heart problems), had undergone have been well-established. It is nevertheless of or on waiting list for a heart surgery (heart bypass, growing concern that the bene#ts conferred by angioplasty, angiography), or on any of cardiac drugs combination of the drugs are potentially o"set by (ATC code C01) or warfarin (ATC code B01AA). Patterns perceived deterioration on health-related quality of life of cardiovascular drug use were classi#ed as no use, (HRQoL) attributable to pill burden. using any antihypertensives, lowering agents or antiplatelet drugs, using any two combinations, and Objectives. A cross-sectional study was conducted using all the three classes of medications. Quality of life to determine the extent of use of cardiovascular was measured with the use of the SF-36, focusing on medications in elderly Australian women with the physical functioning, general health, vitality and diabetes–either individually or in combination–for mental health subscales. Linear regression analyses primary and secondary prevention of cardiovascular of survey data evaluated the associations between disease. This study further examined whether usage usage patterns of cardiovascular medication and patterns of cardiovascular medications have e"ects on individual subscales of the SF-36 while controlling for their health-related quality of life. other sociodemographic, health behaviour and health Methods. A subset of the older cohort completing service utilisation characteristics. Survey 4 in the ALSWH who self-reported to have Results. Of 7,158 older women retained at Survey 4, been diagnosed with diabetes and/or use medications 885 were identi#ed as having diabetes among which indicative of diabetes were selected as study subjects. 390 (46.8%) had macrovascular disease. Twenty- Use of cardiovascular medications was identi#ed from three percent of the diabetic women used any one self-reports on usage of medications belonging to the category of antihypertensives, lipid lowering drugs Anatomical Theraupetic Chemical (ATC) code B01AC or antiplatelets, 37.5% reported use of a combination (platelet aggregation inhibitors), C03 (), C07 of any two and 29.1% were on all three categories (β-blockers), C08 (calcium channel blockers), C09 of medicines. Using at least one cardiovacular drug (agents acting on the renin-angiotensin system), C02 was shown to be associated with higher HRQoL (other antihypertensives) and C10 (lipid modifying scores. After adjustment for other covariates, being agents). Prevention stage of cardiovascular disease

80 50

40 60

30 40 20

20 Prevalence of of Prevalence use (%) Prevalence of of Prevalence use (%) 10

0 0 Antiplatelet CCB Other AH None Dual combination LLA B-blocker ACEI/ARB Single treatment Triple combination

A Without MVDW ith MVD 95% CI B Without MVDW ith MVD9 5% CI Figure 1. Cardiovascular medication use by presence of macrovascular Figure 2. Radar chart of the quality of life models. Di$erent markers disease. Panel A shows usage prevalences of antiplatelet, lipid connected with their corresponding lines represent regression lowering drug and antihypertensive classes. Panel B shows the overall coe"cients of each QoL subscales. A coe"cient of 0 means no pattern of cardiovascular drug use. Signi#cant estimate di$erences associations between variables and QoL scores are found. Usages between the two groups (with & without MVD) are indicated by of cardiovascular medication are mostly shown to be subjectively non-overlapped 95% CIs. Abbreviations: LLA, lipid lowering agent; bene#cial as markers reside in outer area, while other covariates CCB, calcium ; ACEI, angiotensin converting enzyme are shown to have negative e$ects on QoL indicated by markers inhibitor; ARB, angiotensin II receptor blocker; AH, antihypertensive; sitting within grey area. Abbreviations: QoL, quality of life; CAM, MVD, macrovascular disease; CI, con#dence interval. complementary and alternative medicines; GP, general practitioner

42 AUSTRALIAN LONGITUDINAL STUDY ON WOMEN’S HEALTH I ANNUAL REPORT 2009 on triple combination of cardiovascular drugs was Conclusion. The use of cardiovascular medications signi#cantly associated with increased scores on in elderly Australian women with diabetes was physical functioning (coe=cient 16.134, 95% CI reasonably high particularly for the secondary 6.940, 25.327), general health (10.058, 95% CI 2.649, prevention of cardiovascular disease. Use of multiple 17.468) and mental health subscales (12.896, 95% cardiovascular drugs was demonstrated to be CI 6.562, 15.882). Being on any dual combination subjectively bene#cial in terms of perceived physical was signi#cantly associated with increased scores functioning, general health and mental health. There on physical functioning (coe=cient 14.744, 95% remains a possibility that being on more intensive CI 5.988, 23.501) and general health (8.334, 95% CI regimens with more cardiovascular drugs will diminish 1.200, 15.467), whereas using a single cardiovascular patients’ HRQoL since the remaining subscales of the drug is only signi#cantly associated with increased SF-36 were not evaluated. If HRQoL in diabetics is to be score on physical functioning (coe=cient 12.346, 95% more comprehensively assessed, there may be value in CI 3.943, 20.750). A negative association was found employing a diabetes-speci#c instrument as an add-on between using three cardiovascular drugs and vitality to the generic HRQoL instrument. score albeit modest and statistically nonsigni#cant (coe=cient -1.342, 95% CI -7.927, 5.242).

Changes in young women’s health behaviours in response to traumatic events Candidate: Toni Lindsay Degree: Master of Health Psychology University: School of Behavioural Sciences, University of Newcastle Supervisors: Dr Deborah Loxton (Research Centre for Gender, Health and Ageing, University of Newcastle) & A/Professor Jenny Bowman (School of Psychology, University of Newcastle) Several studies have examined the role of speci#c generalised estimating equations to examine these types of trauma (E.g., sexual and physical trauma) on relationships, #nding that following a major traumatic the behaviours of women, including their use of health event/s women were signi#cantly more likely to start behaviours such as smoking, alcohol and illicit drug using the above negative health behaviours. Women use (Rheinhold et al., 2004, Chang, Skinner & Boehmer., who had higher numbers of ongoing life events were 2001, Lang et al., 2003, Hapke et al., 2005 and Win#eld also signi#cantly more likely to start using negative et al., 1990). This study expanded these #ndings to health behaviours. This study, using the ALSWH data examine the relationship between both major trauma has been able to expand substantially on providing and ongoing life events and the use of tobacco, risky further knowledge about the ways in which women drinking, illicit drug use, unhealthy eating behaviours, develop various types of health behaviours following self harm and suicidal ideation in young women. The traumatic and ongoing life events over time. longitudinal mailed survey of 7675 women utilised

AUSTRALIAN LONGITUDINAL STUDY ON WOMEN’S HEALTH I ANNUAL REPORT 2009 43