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Cardioprotective medication use and risk factor control among US adults with unrecognized myocardial infarction: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.

Levitan EB, Gamboa C, Safford MM, Rizk DV, Brown TM, Soliman EZ, Muntner P - Vasc Health Risk Manag (2013)

Bottom Line: Blood pressure control (,140/90 mmHg) was similar between RMI and UMI groups (prevalence ratio = 1.03, 95% confidence interval 0.93-1.13).Although participants with UMI were somewhat more likely to use cardioprotective medications than those with no MI, they were less likely to use cardioprotective medications and to have controlled low-density lipoprotein cholesterol than participants with RMI.Increasing appropriate treatment and risk factor control among individuals with UMI may reduce risk of mortality and future cardiovascular events.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294-0022, USA. elevitan@uab.edu

ABSTRACT

Background: Individuals with unrecognized myocardial infarction (UMI) have similar risks for cardiovascular events and mortality as those with recognized myocardial infarction (RMI). The prevalence of cardioprotective medication use and blood pressure and low-density lipoprotein cholesterol control among individuals with UMI is unknown.

Methods: Participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who were recruited between May 2004 and October 2007 received baseline twelve-lead electrocardiograms (n = 21,036). Myocardial infarction (MI) status was characterized as no MI, UMI (electrocardiogram abnormalities consistent with MI without self-reported history; n = 949; 4.5%), and RMI (self-reported history of MI; n = 1574; 7.5%).

Results: For participants with no MI, UMI, and RMI, prevalence of use was 38.4%, 44.4%, and 75.7% for aspirin; 18.0%, 25.8%, and 57.2% for beta blockers; 31.7%, 38.7%, and 55.0% for angiotensin converting enzyme inhibitors or angiotensin receptor blockers; and 28.1%, 33.9%, and 64.1% for statins, respectively. Participants with RMI were 35% more likely to have low-density lipoprotein cholesterol < 100 mg/dL than participants with UMI (prevalence ratio = 1.35, 95% confidence interval 1.19-1.52). Blood pressure control (,140/90 mmHg) was similar between RMI and UMI groups (prevalence ratio = 1.03, 95% confidence interval 0.93-1.13).

Conclusion: Although participants with UMI were somewhat more likely to use cardioprotective medications than those with no MI, they were less likely to use cardioprotective medications and to have controlled low-density lipoprotein cholesterol than participants with RMI. Increasing appropriate treatment and risk factor control among individuals with UMI may reduce risk of mortality and future cardiovascular events.

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Related in: MedlinePlus

Medication use by myocardial infarction status.Abbreviations: ACEI/ARB, angiotensin converting enzyme inhibitor or angiotensin receptor blocker; MI, myocardial infarction; RMI, recognized myocardial infarction; UMI, unrecognized myocardial infarction.
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f1-vhrm-9-047: Medication use by myocardial infarction status.Abbreviations: ACEI/ARB, angiotensin converting enzyme inhibitor or angiotensin receptor blocker; MI, myocardial infarction; RMI, recognized myocardial infarction; UMI, unrecognized myocardial infarction.

Mentions: The use of aspirin, beta blockers, ACEI/ARBs, and statins among participants with UMI was more similar to those with no MI than RMI (Figure 1 and Table 2). The prevalence of use of one or more, two or more, three or more, and all four medications in people with UMI was slightly higher than the prevalence among individuals with no MI and lower than the prevalence among individuals with RMI. After adjusting for age, race, and sex, the difference in the prevalence of aspirin use between people with UMI and people with no MI was no longer statistically significant (P = 0.09). For all other comparisons, the prevalence of medication use differed significantly across MI status. When aspirin and clopidogrel were grouped together, the prevalence of use was 39.6% in participants with no MI, 46.2% in participants with UMI, and 79.2% in participants with RMI group. Prevalence ratios for aspirin or clopidogrel were similar to aspirin only (the prevalence ratio for UMI compared to no MI = 1.07 [95% confidence interval 1.00–1.15] and RMI compared to no MI = 1.74 [95% confidence interval 1.68–1.80]).


Cardioprotective medication use and risk factor control among US adults with unrecognized myocardial infarction: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.

Levitan EB, Gamboa C, Safford MM, Rizk DV, Brown TM, Soliman EZ, Muntner P - Vasc Health Risk Manag (2013)

Medication use by myocardial infarction status.Abbreviations: ACEI/ARB, angiotensin converting enzyme inhibitor or angiotensin receptor blocker; MI, myocardial infarction; RMI, recognized myocardial infarction; UMI, unrecognized myocardial infarction.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3569379&req=5

f1-vhrm-9-047: Medication use by myocardial infarction status.Abbreviations: ACEI/ARB, angiotensin converting enzyme inhibitor or angiotensin receptor blocker; MI, myocardial infarction; RMI, recognized myocardial infarction; UMI, unrecognized myocardial infarction.
Mentions: The use of aspirin, beta blockers, ACEI/ARBs, and statins among participants with UMI was more similar to those with no MI than RMI (Figure 1 and Table 2). The prevalence of use of one or more, two or more, three or more, and all four medications in people with UMI was slightly higher than the prevalence among individuals with no MI and lower than the prevalence among individuals with RMI. After adjusting for age, race, and sex, the difference in the prevalence of aspirin use between people with UMI and people with no MI was no longer statistically significant (P = 0.09). For all other comparisons, the prevalence of medication use differed significantly across MI status. When aspirin and clopidogrel were grouped together, the prevalence of use was 39.6% in participants with no MI, 46.2% in participants with UMI, and 79.2% in participants with RMI group. Prevalence ratios for aspirin or clopidogrel were similar to aspirin only (the prevalence ratio for UMI compared to no MI = 1.07 [95% confidence interval 1.00–1.15] and RMI compared to no MI = 1.74 [95% confidence interval 1.68–1.80]).

Bottom Line: Blood pressure control (,140/90 mmHg) was similar between RMI and UMI groups (prevalence ratio = 1.03, 95% confidence interval 0.93-1.13).Although participants with UMI were somewhat more likely to use cardioprotective medications than those with no MI, they were less likely to use cardioprotective medications and to have controlled low-density lipoprotein cholesterol than participants with RMI.Increasing appropriate treatment and risk factor control among individuals with UMI may reduce risk of mortality and future cardiovascular events.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294-0022, USA. elevitan@uab.edu

ABSTRACT

Background: Individuals with unrecognized myocardial infarction (UMI) have similar risks for cardiovascular events and mortality as those with recognized myocardial infarction (RMI). The prevalence of cardioprotective medication use and blood pressure and low-density lipoprotein cholesterol control among individuals with UMI is unknown.

Methods: Participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who were recruited between May 2004 and October 2007 received baseline twelve-lead electrocardiograms (n = 21,036). Myocardial infarction (MI) status was characterized as no MI, UMI (electrocardiogram abnormalities consistent with MI without self-reported history; n = 949; 4.5%), and RMI (self-reported history of MI; n = 1574; 7.5%).

Results: For participants with no MI, UMI, and RMI, prevalence of use was 38.4%, 44.4%, and 75.7% for aspirin; 18.0%, 25.8%, and 57.2% for beta blockers; 31.7%, 38.7%, and 55.0% for angiotensin converting enzyme inhibitors or angiotensin receptor blockers; and 28.1%, 33.9%, and 64.1% for statins, respectively. Participants with RMI were 35% more likely to have low-density lipoprotein cholesterol < 100 mg/dL than participants with UMI (prevalence ratio = 1.35, 95% confidence interval 1.19-1.52). Blood pressure control (,140/90 mmHg) was similar between RMI and UMI groups (prevalence ratio = 1.03, 95% confidence interval 0.93-1.13).

Conclusion: Although participants with UMI were somewhat more likely to use cardioprotective medications than those with no MI, they were less likely to use cardioprotective medications and to have controlled low-density lipoprotein cholesterol than participants with RMI. Increasing appropriate treatment and risk factor control among individuals with UMI may reduce risk of mortality and future cardiovascular events.

Show MeSH
Related in: MedlinePlus