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Studies on the Association between Phenylpropanolamine (PPA) and Hemorrhagic Stroke in Other Countries.
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Seung Mi Lee, Byung Woo Yoon, Byung Joo Park
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Korean J Epidemiol. 2004;26(2):1-7.
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Abstract
OBJECTIVES
Phenylpropanolamine (PPA) had been used widely as cold remedies or appetite suppressants. However, products containing PPA were withdrawn in sequence in the US, Japan, and Korea due to the increased risk of hemorrhagic stroke.
The purpose of this paper was to review safety issues related with the PPA use and hemorrhagic stroke in view of pharmacoepidemiology and pharmacovigilance.METHODS AND MATERIALS: Researches conducted for evaluating the association between the PPA use and hemorrhagic stroke in other countries were reviewed, which involved case reports, case series, case-control studies, and cohort studies.RESULTS In terms of pharmacologic and clinical features, PPA may increase the risk of hemorrhagic stroke through increased blood pressure, heart rate, or vasculitis. The association between the PPA use and hemorrhagic stroke among young women was suggested by case reports from spontaneous adverse events reporting systems or medical journals. The cohort study, using the large prescription database in the US and published in 1984, failed to reveal the association in the population aged below 65. The case-control study conducted as the Yale Hemorrhagic Stroke Project, published in 2000, was the first study to find the association between the PPA as appetite suppressants and hemorrhagic stroke among women ages 18-49 years by well-designed analytic epidemiological research. It led to withdrawal of all products containing PPA in the US and many other countries since 2000. However, the association between PPA and cerebral hemorrhage could not be confirmed by the case-control study conducted in Mexico due to inappropriate recruitment of control group.CONCLUSIONS During several years case reports have suggested that hemorrhagic stroke could be induced by PPA, and the Yale Hemorrhagic Stroke Project revealed the association by case-control study and provided a useful model for pharmacovigilance. Nevertheless, their finding could not be applied to other population such as elderly women and male population. And they could not provide any evidence on the association between PPA and stroke when PPA was used as cold remedy taken daily dose below 100mg.
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Lung cancer incidence, mortality and survival rate in Korean Elderly Pharmacoepidemiologic Cohort(KEPEC) in 1994-1998.
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Nam Kyong Choi, Kyung Eun Youn, Dae Seuk Heo, Yooni Kim, Seung Mi Lee, Byung Joo Park
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Korean J Epidemiol. 2002;24(2):121-130.
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PURPOSE
This study was conducted to estimate incidence, mortality and survival rate of lung cancer in the elderly people in Korea.METHODS Study population was Korean Elderly Phamacoepidemiologic Cohort (KEPEC). The lung cancer incidence cases were detected from three different sources, medical utilization database of the Korea Medical Insurance Corporation (KMIC), the database from the National Cancer Registry, and the database from the Regional Cancer Registry. The hospital survey to confirm the final diagnosis of the potential cases was conducted. A specialist on lung cancer reviewed the abstracted data to confirm the final diagnoses. The lung cancer death cases were detected from the mortality database at National Statistical Office.
Incidence rate, survival rate and mortality rate of lung cancer and their 95% confidence intervals were estimated with SAS Window ver. 8.1.
PESULTS: There were 213 confirmed lung cancer cases in KEPEC between Jan. 1994 and Dec. 1998. Age-standardized incidence rate of lung cancer to the Korean population was estimated to be 316.9 per 100,000 person-years in male and 65.2 per 100,000 person-years in female. Age-standardized mortality rate of lung cancer to the Korean population was estimated to be 342.3 per 100,000 person-years in male and 84.8 per 100,000 person-years in female. One year survival rate was 17% in male and 11% in female. Two year survival rate was 2% in male and 4% in female.CONCLUSION Age-standardized incidence rate, age-standardized mortality rate and survival rate of lung cancer in the elderly Korean may be useful for further study and making health policy for managing lung cancer in the elderly.
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