Meds to prevent heart attack also reduce heart attack severity

By John Murphy, MDLinx
Published September 21, 2016

Key Takeaways

Medications to prevent acute coronary syndrome (ACS) also reduce the severity of disease in patients who have an ACS event, according to research published September 14, 2016 in PLoS ONE.

“Cardioprotective medications such as aspirin, statins, and beta-blockers are prescribed to patients who have high risk of a heart attack because they reduce the chance of a first or repeat event,” said first author Dr. Min Li, a researcher in the Department of Epidemiology and Biostatistics at Peking University Health Science Centre, in Beijing, China.

However, she added: “Until now, it was not known whether these drugs provided any benefit to patients who develop a heart attack despite taking the medication.”

To find out, the researchers assessed 14,790 patients hospitalized for acute coronary syndrome (ACS) in 75 hospitals in China. The researchers sought to determine whether any of 4 preventive medications—antiplatelet agents (aspirin or clopidogrel), statins, beta-blockers, and angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB)—were associated with reduced severity of disease at presentation or fewer complications during hospitalization.

Analyses showed that prior use of each medication was significantly associated with reduced disease severity, fewer arrhythmias, and less risk of major adverse cardiovascular events (MACEs) during hospitalization, even after adjusting for multiple confounding factors. Many of the associations became non-significant after adjusting for severity of disease at presentation (with the notable exception of prior ACEI/ARB use).

“Each of the four preventive medications was associated with a reduction in poor clinical outcomes,” Dr. Li said. “The fact that many associations were not significant after we adjusted for disease severity suggests that these drugs may reduce the seriousness of ACS events, which lessens the clinical impact.”

One downside: Prior use of antiplatelet agents was associated with increased risk of hemorrhagic stroke, and this association remained after adjusting for disease severity at presentation.

The researchers also found that the greater the number of the 4 medications that a patient used, the lower the risk of clinical outcomes. For instance, taking 1 medication reduced the risk of MACEs by 23%, taking 2 medications reduced the risk by 33%, 3 medications by 52%, and 4 medications by 41%. The same trend was found for severity of disease and occurrence of arrhythmias. Patients with and without a history of CVD demonstrated similar results.

“Our findings suggest that the benefits of these medications may extend beyond preventing ACS. They may also reduce the severity of disease and in-hospital adverse outcomes in those who develop an ACS despite taking the drugs,” Dr. Li noted. “The additional benefits of the four preventive medications were observed in patients with and without a CVD history, reducing the severity of repeat and first events.”

“Patients who still develop ACS while using the drugs should not lose confidence but continue to use them because they do help,” she advised.

This study was funded by Sanofi, China.

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