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Survival benefit from calcium channel blockers in elderly blacks following acute myocardial infarction
Deborah Williams1, Kyung Sook Kim, Lucile L Adams-Campbell
1Howard University College of Medicine, Washington, DC, USA. dwilliams@fac.howard.edu
Insights
Elderly African Americans with acute myocardial infarction (AMI) face higher mortality. Calcium channel blockers (CCBs) improved survival in both Black and White elderly patients, though Black patients still had lower survival rates.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Elderly survivors of acute myocardial infarctions (AMI) have increased mortality, with elderly African Americans experiencing the highest rates.
- Hypertension is a significant risk factor contributing to higher AMI mortality in elderly African Americans.
- Calcium channel blockers (CCBs) are considered safe for elderly AMI survivors.
Purpose of the Study:
- To evaluate the impact of CCBs on survival in elderly patients following AMI.
- To investigate potential ethnic disparities in CCB effectiveness for AMI survival.
- To determine if CCB therapy mitigates the increased mortality risk in elderly African Americans post-AMI.
Main Methods:
- Retrospective analysis of the Cooperative Cardiovascular Project (CCP) database (1994-1995).
- Inclusion criteria: Patients aged 65 years or older admitted with acute myocardial infarction (ICD-9 code 410).
- Data analysis focused on trends in CCB usage and 2-year survival rates across ethnic groups.
Main Results:
- Elderly African Americans had a higher incidence of hypertension (79.1%) compared to Whites (60.4%).
- CCB use was higher in Blacks (31.2%) than Whites (27.3%).
- Despite lower baseline survival, CCB treatment improved 2-year survival rates in both Whites (51% to 71.2%) and Blacks (55.7% to 68.5%).
Conclusions:
- Elderly Black patients exhibited higher mortality rates post-AMI compared to elderly White patients.
- Calcium channel blocker therapy demonstrated a survival benefit for both ethnic groups.
- While CCBs improved survival, Black patients continued to have lower survival rates than White patients when treated with CCBs.
Background:
Calcium channel blockers (CCBs) have been used in elderly survivors of acute myocardial infarctions (AMI) and have been found to be safe in this setting. While the elderly have increased mortality following AMI, an ethnic disparity exists, with elderly African Americans having the highest mortality. It is proposed that much of the increased mortality in elderly African Americans may be related to their greater incidence of risk factors at the time of AMI, particularly hypertension. We proposed that elderly African Americans would receive survival benefits from the blood pressure lowering effects of CCBs.
Methods:
We analyzed the Cooperative Cardiovascular Project (CCP) database to evaluate the impact of CCBs on survival in elderly patients with AMI. This database comprises patients admitted to US hospitals during 1994-1995 with a diagnosis of acute myocardial infarction. A retrospective chart analysis was performed to identify patients aged 65 years or older admitted with ICD-9 code 410 for acute myocardial infarction. Data were analyzed for trends.
Results:
Of all elderly AMI admissions, 144,233 were Whites, and 9,906 were Blacks. Hypertension was common in both Whites and Blacks, 60.4% and 79.1%, P<.001, respectively. Calcium channel blockers were used with 27.3% of Whites, and 31.2% of Blacks, P<.001. Blacks had a lower 2-year survival rate, regardless of CCB status, with a 55.7% 2-year survival rate, compared to a 51% 2-year survival rate in Whites. However, in both Blacks and Whites, 2-year survival improved with CCB treatment to a 71.2% 2-year survival rate in Whites and a 68.5% 2-year survival rate in Blacks. Subset analysis by type of CCB demonstrated better survival rates with both dihydropyridine and non-dihydropyridine CCBs, compared to no CCBs, although there was a survival trend favoring non-dihydropyridine CCBs.
Conclusions:
Elderly Blacks had a higher mortality rate in the CCP database than elderly Whites, at each time frame. Calcium channel blocker therapy was associated with improved survival in both Whites and Blacks, although Blacks continued to have lower survival rates with CCBs when compared with Whites.
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