Patients with a first acute MI who took medication
— aspirin, beta-blockers, ACE inhibitors or statins — before hospital
admission had a lower risk of presenting with STEMI, according to new study
findings.
The study population included 103,459 consecutive
patients from the Register of Information and Knowledge about Swedish Heart
Intensive Care Admissions (RIKS-HIA) admitted between 1996 and 2006 who had a
first acute MI.
Researchers reported that the patients with STEMI
(n=45,027, 43.5%) were younger, had less prior CVD and used fewer medications
before hospitalization. Overall, 61.4% of STEMI patients used no medication vs.
45.9% in the non-STEMI group. Patients who used aspirin, beta-blockers,
ACE inhibitors and statins before hospitalization had lower
odds of presenting with STEMI. The risk decreased with the number of previous
medications, with at least three medications being associated with a multiply
adjusted OR of presenting with
STEMI of 0.48 (99% CI, 0.44-0.52) vs. no medications at
admission.
Among study patients, researchers concluded that
“previous treatment with aspirin, beta-blockers, ACE inhibitors and
statins was substantially associated with less risk of presenting with STEMI, a
more damaging and severe acute MI. Increasing use of preventive medications in
the population could contribute to decreasing severity in acute MI, further
emphasizing the importance of medical treatment in patients perceived to be at
high risk.”
However, in an accompanying editorial, Eyal Herzog,
MD, and Fahad Javed, MD, both with Columbia University in New York,
said before physicians too strongly embrace pharmacological treatment, they
should remember that the risk for MI is almost entirely attributable to
modifiable CV risk factors.
“An extensive body of data demonstrates the
positive impact of cessation of smoking, an increase in physical exercise,
reduction of body weight, control of hypertension and correction of
dyslipidemias,” they wrote. “Unfortunately, adherence to
evidence-based pharmacologic treatment and lifestyle modifications are
sub-optimal in various populations. We know what works; now we have to put our
evidence to use.”