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[Drug treatment for secondary prevention of myocardial infarction]
K Ishikawa1, K Kanamasa, T Hayashi
1First Department of Internal Medicine, Kinki University School of Medicine, Osaka.
Insights
Cholesterol lowering agents and beta-blockers significantly reduced cardiac events in myocardial infarction patients. Conversely, antiarrhythmic agents increased cardiac events, highlighting the need for further placebo-controlled studies.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Investigated drug effects on cardiac events in 1,483 myocardial infarction patients over 11 years.
- Included 1,164 men and 319 women with a mean age of 60.1 years.
- Follow-up duration averaged 17.4 months.
Purpose:
- To evaluate the impact of various drug treatments on cardiac events post-myocardial infarction.
- To identify medications that reduce or increase the risk of recurrent cardiac events.
Summary:
- Multivariate analysis indicated cholesterol lowering agents and beta-blockers reduced cardiac events.
- Antiarrhythmic agents were associated with an increased incidence of cardiac events.
- Univariate analysis confirmed significant reductions in cardiac events with cholesterol lowering agents, beta-blockers, and antiplatelet agents.
Impact:
- Findings suggest specific drug classes can mitigate cardiac events, while others may exacerbate risk.
- Highlights the potential benefits of statins and beta-blockers in post-MI care.
- Calls for a large, placebo-controlled multicenter study to validate these observations.
Abstract:
The effects of drug treatment on cardiac events for 11 years from January 1986 to December 1996 were investigated in 1,483 patients with myocardial infarction, 1,164 men and 319 women (mean age 60.1 +/- 11.2 years), followed up for 17.4 +/- 20.9 months. Seventy-one patients (4.8%, 33 cases per 1,000 person-year) had cardiac events (recurrent myocardial infarction, sudden death and death by congestive heart failure). Multivariate analysis showed treatment with cholesterol lowering agents and beta-blockers reduced cardiac events, whereas administration of antiarrhythmic agents increased cardiac events. Univariate analysis showed that the incidence of cardiac events was 2.2% in patients treated with cholesterol lowering agents but 6.2% in patients without treatment, showing a significant difference (p < 0.01). The incidence was 3.2% for patients treated with beta-blockers and 6.8% for those without (p < 0.01), showing that beta-blockers were also effective to reduce cardiac events. Antiplatelet agents were also effective (3.7% vs 7.1%, p < 0.01). Calcium antagonists, angiotensin converting enzyme inhibitors and warfarin were not effective. Nitrates (6.0% vs 3.1%, p < 0.01) and antiarrhythmic agents (13.7% vs 3.6%, p < 0.01) increased the incidence of cardiac events. A placebo-controlled, double blind, large clinical multicenter study is required to confirm these results.