Medication use in relation to noise from aircraft and road traffic in six European countries: results of the HYENA study.

OBJECTIVES: Studies on the health effects of aircraft and road traffic noise exposure suggest excess risks of hypertension, cardiovascular disease and the use of sedatives and hypnotics. Our aim was to assess the use of medication in relation to noise from aircraft and road traffic. METHODS: This cross-sectional study measured the use of prescribed antihypertensives, antacids, anxiolytics, hypnotics, antidepressants and antasthmatics in 4,861 persons living near seven airports in six European countries (UK, Germany, the Netherlands, Sweden, Italy, and Greece). Exposure was assessed using models with 1 dB resolution (5 dB for UK road traffic noise) and spatial resolution of 250×250 m for aircraft and 10×10 m for road traffic noise. Data were analysed using multilevel logistic regression, adjusting for potential confounders. RESULTS: We found marked differences between countries in the effect of aircraft noise on antihypertensive use; for night-time aircraft noise, a 10 dB increase in exposure was associated with ORs of 1.34 (95% CI 1.14 to 1.57) for the UK and 1.19 (1.02 to 1.38) for the Netherlands but no significant associations were found for other countries. For day-time aircraft noise, excess risks were found for the UK (OR 1.35; CI: 1.13 to 1.60) but a risk deficit for Italy (OR 0.82; CI: 0.71 to 0.96). There was an excess risk of taking anxiolytic medication in relation to aircraft noise (OR 1.28; CI: 1.04 to 1.57 for daytime and OR 1.27; CI: 1.01 to 1.59 for night-time) which held across countries. We also found an association between exposure to 24hr road traffic noise and the use of antacids by men (OR 1.39; CI 1.11 to 1.74). CONCLUSION: Our results suggest an effect of aircraft noise on the use of antihypertensive medication, but this effect did not hold for all countries. Results were more consistent across countries for the increased use of anxiolytics in relation to aircraft noise.

Saliva cortisol and exposure to aircraft noise in six European countries.

BACKGROUND: Several studies show an association between exposure to aircraft or road traffic noise and cardiovascular effects, which may be mediated by a noise-induced release of stress hormones. OBJECTIVE: Our objective was to assess saliva cortisol concentration in relation to exposure to aircraft noise. METHOD: A multicenter cross-sectional study, HYENA (Hypertension and Exposure to Noise near Airports), comprising 4,861 persons was carried out in six European countries. In a subgroup of 439 study participants, selected to enhance the contrast in exposure to aircraft noise, saliva cortisol was assessed three times (morning, lunch, and evening) during 1 day. RESULTS: We observed an elevation of 6.07 nmol/L [95% confidence interval (CI), 2.32-9.81 nmol/L] in morning saliva cortisol level in women exposed to aircraft noise at an average 24-hr sound level (L(Aeq,24h)) > 60 dB, compared with women exposed to L(Aeq,24h) < or = 50 dB, corresponding to an increase of 34%. Employment status appeared to modify the response. We found no association between noise exposure and saliva cortisol levels in men. CONCLUSIONS: Our results suggest that exposure to aircraft noise increases morning saliva cortisol levels in women, which could be of relevance for noise-related cardiovascular effects.

Predictors of mortality in adult patients with congestive heart failure receiving nesiritide--retrospective analysis showing a potential adverse interaction between nesiritide and acute renal dysfunction.

BACKGROUND: A recent meta-analysis has suggested that nesiritide (NES), a new agent for the treatment of congestive heart failure (CHF), is associated with an increased risk of short-term mortality. METHODS: We retrospectively examined this issue among 1407 consecutive elderly CHF patients by Pearson's chi-squared test, and determined independent risk factors for 60-day mortality by multivariate analysis in a cohort of 682 patients for whom we had sufficient clinical and laboratory data. RESULTS: Univariate analysis revealed that NES usage was associated with increased mortality (n=1407, 10 vs 6%, P=0.011; n=682, 19 vs 12.5%, P=0.046). However, by forward stepwise regression analysis, NES usage did not survive as an independent predictor of mortality. The following variables were independent predictors of mortality: development of acute renal failure (ARF) defined as an increase of serum creatinine (SCr) >or= 0.5 mg/dl; lack of beta-adrenergic blockade; increased admission blood urea nitrogen; digoxin use; and increased admission brain natriuretic peptide. When patients were stratified according to NES usage, ARF emerged as an independent risk factor for mortality only among patients who received NES. Strikingly, among CHF patients who developed ARF (n=102), NES usage emerged as the only independent predictor of mortality (P=0.006, OR=3.73, 95% CI 1.45-9.56). CONCLUSION: We conclude that, while NES per se is not independently associated with an increased risk for mortality, the development of ARF in association with NES use may confer an increased risk of mortality.

Predictors of worsening renal function in adult patients with congestive heart failure receiving recombinant human B-type brain natriuretic peptide (nesiritide).

BACKGROUND: A recent meta-analysis suggested that the use of nesiritide (NES), a new agent for the treatment of congestive heart failure (CHF), is associated with an increased risk of acute renal failure (ARF). METHODS: We examined this issue among 219 consecutive CHF patients, and determined the risk factors for development of ARF [defined as a rise in serum creatinine (SCr) >0.3 mg/dl]. The sole primary outcome was the development of ARF. RESULTS: Seventy one of 219 patients received NES. There was no difference in ARF between patients receiving vs not receiving NES (29 vs 20%, P = 0.17). Evaluation of the entire cohort employing forward stepwise regression analysis revealed the following independent predictors of ARF: admission blood urea nitrogen (BUN) [P = 0.0004, odds ratio (OR) = 1.026], and admission brain natiuretic peptide (P = 0.04, OR = 1.0003). We repeated the same analysis for the subgroups of patients receiving or not receiving NES. For patients not receiving NES (n = 148), ARF developed in 30 (20%), with lower estimated glomerular filtration rate and older age being independent predictors. For patients receiving NES (n = 71), ARF developed in 21 (29%), with hypertension, elevated BUN/SCr ratio, and lack of use of angiotensin inhibitors being independent predictors. CONCLUSION: Among all patients with CHF, the use of NES was not an independent risk factor for the development of ARF. However, risk factors for developing ARF differed among patients receiving vs not receiving NES. Comparison of these differing factors suggests that administering NES in the setting of diminished renal perfusion and/or altered renal autoregulation may confer an increased risk of ARF.