Underuse of cardiovascular preventive pharmacotherapy in patients presenting with ST-elevation myocardial infarction

• Published in: The American heart journal Vol. 164; no. 2; pp. 259 - 267
• Main Authors: Miedema, Michael D., MD, Cohn, Jay N., MD, Garberich, Ross F., MS, Knickelbine, Thomas, MD, Graham, Kevin J., MD, Henry, Timothy D., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-08-2012; Mosby; Elsevier Limited
• Subjects: Age; Aged; Aspirin - therapeutic use; Biological and medical sciences; Body mass index; Cardiology. Vascular system; Cardiovascular; Cardiovascular Agents - therapeutic use; Cardiovascular disease; Coronary heart disease; Demographics; Diabetes; Disease prevention; Drug therapy; Electrocardiography; Family medical history; Female; Gender; Health care expenditures; Health care policy; Heart; Heart attacks; Hospitals; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hypertension; Male; Medical records; Medical sciences; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - prevention & control; Myocarditis. Cardiomyopathies; Risk assessment; Risk Factors; Stroke; Human; Myocardial infarction; Prevention; ST elevation; Symptomatology; Cardiovascular disease; Patient; Circulatory system; Cardiology; Coronary heart disease; Myocardial disease; Inaugural sign
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2012.05.008

Background Multiple medications have proven efficacy for the primary prevention of coronary heart disease (CHD), but the appropriate patient population remains controversial. Even in the presence of multiple cardiovascular risk factors, many patients are not considered high risk and are not offered preventive medications despite proven efficacy. Methods We analyzed a prospective cohort of 1,710 consecutive ST-elevation myocardial infarction (STEMI) patients treated in a regional STEMI system from May 2007 to July 2010 and enrolled in a comprehensive database that includes preadmission medications. Results Of the 1,707 patients analyzed, 1,180 (69.1%) did not have known CHD before their event; and 482 (41.7%) of those patients had premature events (men < 55 years old, women < 65 years old). In patients without known CHD, cardiovascular risk factors were abundant (52.1% had hypertension, 43.6% had dyslipidemia, 41.4% had a family history of CHD, 58.5% were current or former smokers, and 14.9% were diabetic). Despite the high prevalence of risk factors, only 24.1% were on aspirin, 16.1% were on a statin, and only 7.8% were taking an aspirin and statin. Use of preventive medications was even less common in patients with premature events, including aspirin (15.2% vs 30.2%, P value < .001), statins (11.1% vs 19.5%, P value < .001), and the combination (5.6% vs 9.4%, P value < .001). Conclusions Approximately 70% of a contemporary STEMI population did not have known CHD before their event, and > 40% of those events would be considered premature. Despite the significant burden of cardiovascular risk factors, use of preventive therapy was alarmingly low in patients presenting with STEMI.