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Long-term nitrate treatment increases cardiac events in patients with healed myocardial infarction. Secondary
K Ishikawa1, K Kanamasa, I Ogawa
1First Department of Medicine, Kinki University, School of Medicine, Osaka, Japan.
Insights
Long-term nitrate treatment in patients with healed myocardial infarction was linked to a higher incidence of cardiac events. This study suggests potential risks associated with prolonged nitrate use in this patient population.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Nitrates are known to benefit patients with acute myocardial infarction.
- The long-term effects of nitrates on patients with healed myocardial infarction remain unclear.
Purpose of the Study:
- To investigate the impact of long-term nitrate treatment on cardiac events in patients with healed myocardial infarction.
Main Methods:
- A randomized controlled trial involving 1,002 patients with healed myocardial infarction.
- Patients were divided into two groups: one receiving nitrate treatment and the other not.
- Primary endpoints included recurrent myocardial infarction, death from heart failure, and sudden death over an average observation period of 18 months.
Main Results:
- Patients treated with nitrates experienced cardiac events at a significantly higher rate (6.6%) compared to the non-treated group (3.1%).
- The odds ratio for cardiac events in the nitrate group was 2.17 (95% confidence interval 1.13-4.19), with a p-value < 0.05.
- No significant differences were observed in non-cardiac death or loss to follow-up between the groups.
Conclusions:
- Long-term nitrate therapy was associated with an increased occurrence of cardiac events in patients with healed myocardial infarction.
- Potential mechanisms include nitrate tolerance, rebound effects, and neurohormonal influences.
Background:
Nitrates dilate coronary arteries, ameliorate myocardial ischemia, minimize left ventricular remodeling, and reduce mortality in patients with acute myocardial infarction. However, the effects of long-term treatment with nitrates on cardiac events in patients with healed myocardial infarction are not known.
Methods And Results:
A total of 1,002 patients with healed myocardial infarction (789 male and 213 female) were randomly divided into 2 groups: treatment with nitrates or nontreatment. The mean observation period was 18.0 +/- 19.9 months. Primary end points were nonfatal and fatal recurrent myocardial infarction, death from congestive heart failure, and sudden death. Baseline characteristics of the 2 groups were also compared to determine any effects on outcome. Among the 621 cases treated with nitrates, 41 cases (6.6%) experienced cardiac events during the observation period, whereas only 12 of the 381 cases that were not treated with nitrates (3.1%) had cardiac events. This difference was statistically significant (p < 0.05; odds ratio 2.17; 95% confidence interval 1.13-4.19). There were no differences in the incidence of noncardiac death or being lost to follow-up between the 2 groups. Although the precise mechanism of this increase in the occurrence of cardiac events by long-term treatment with nitrates is not clear, nitrate tolerance with possible rebound and neurohormonal effects may be involved.
Conclusion:
Long-term treatment with nitrates increased cardiac events in patients with healed myocardial infarction.