Greater use of guideline-recommended medications may lower the risk for death after a first myocardial infarction in patients on hemodialysis.
In a Taiwanese study of 1471 patients on hemodialysis hospitalized with myocardial infarction (mean age 68 years; 41.9% women), clinicians prescribed 1, 2, 3, and 4 cardioprotective medications to 19.1%, 27.6%, 33.3%, and 20% of patients, respectively. Guideline-recommended medications for secondary prevention of myocardial infarction included antiplatelets, β-blockers, statins, and renin-angiotensin-aldosterone system inhibitors. During a median follow-up of 1 year, 458 (31.1%) patients died.
In adjusted analyses, each additional medication was significantly associated with a 12% decreased risk for all-cause mortality, Ting-Yun Lin, MD, of Tzu Chi University in Hualien, Taiwan, and colleagues reported in Clinical Kidney Journal. Results appeared consistent by age, sex, and relevant conditions (dyslipidemia, diabetes, heart failure, revascularization, and ST elevation myocardial infarction).
“Our results have important therapeutic implications, suggesting that more aggressive medical treatment may improve the quality of care for [hemodialysis] patients with [myocardial infarction] and should be considered in this population,” Dr Lin’s team stated. It remains important to weigh the potential risks of these medications and to monitor patients during treatment, they added.
The investigators noted that patients with kidney failure have both traditional cardiovascular risk factors and novel risk factors such as chronic inflammation, calcium and phosphorus abnormalities, sodium and volume overload, and endothelial dysfunction due to uremia. Underutilization of cardioprotective medications in the dialysis population may be driven partly by the lack of clinical trial evidence, but high-risk patients are unlikely to be included in such trials.
Lin TY, Hsieh TH, Hung SC, et al. Association of secondary prevention medication use after myocardial infarction with mortality in hemodialysis patients. Clin Kidney J. Published online July 23, 2022. doi:10.1093/ckj/sfac170