Statin, ACEI/ARB Nonadherence Dangerous After Heart Attack

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Adherence to beta-blockers may not be as beneficial to patients after myocardial infarction.
Adherence to beta-blockers may not be as beneficial to patients after myocardial infarction.

(HealthDay News) -- Nonadherence to angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs) and/or statins following acute myocardial infarction (AMI) is associated with higher mortality, according to study published in the Journal of the American College of Cardiology.

Maarit J. Korhonen, PhD, from the University of North Carolina at Chapel Hill, and colleagues identified 90,869 Medicare beneficiaries (≥65 years of age) who had prescriptions for ACE inhibitors/ARBs, beta-blockers, and statins, and survived at least 180 days after AMI hospitalization (from 2008 to 2010). The proportion of days covered (PDC) during 180 days following hospital discharge was used to measure adherence. Follow-up to determine mortality extended up to an additional 18 months.

The researchers found that only 49% of the patients adhered (PDC ≥80%) to all 3 therapies. Compared with being adherent to all 3 therapies, the multivariable-adjusted hazard ratios for mortality were 1.12 (95% confidence interval [CI], 1.04 to 1.21) for being adherent to ACE inhibitors/ARBs and beta-blockers only; 0.98 (95% CI, 0.91 to 1.07) for ACE inhibitors/ARBs and statins only; 1.17 (95% CI, 1.10 to 1.25) for beta-blockers and statins only; 1.19 (95% CI, 1.07 to 1.32) for ACE inhibitors/ARBs only; 1.32 (95% CI, 1.21 to 1.44) for beta-blockers only; 1.26 (95% CI, 1.15 to 1.38) for statins only; and 1.65 (95% CI, 1.54 to 1.76) for being nonadherent (PDC ≤80%) to all 3 therapies.

"Patients adherent to ACE inhibitors/ARBs and statins only had similar mortality rates as those adherent to all three therapies, suggesting limited additional benefit for beta-blockers in patients who were adherent to statins and ACE inhibitors/ARBs," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

References

Korhonen MJ, Robinson JG, Annis IE, Hickson RP, Simon Bell J, Hartikainen J and Fang G.Adherence Tradeoff to Multiple Preventive Therapies and All-Cause Mortality After Acute Myocardial Infarction. J Am Coll Card. doi: 10.1016/j.jacc.2017.07.783

Peterson ED and Navar AM. Sticky” Issues for Adherence in Secondary Prevention. J Am Coll Card. doi:10.1016/j.jacc.2017.07.788

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