Statin and β-Blocker Therapy and the Initial Presentation of Coronary Heart Disease

  1. Alan S. Go, MD;
  2. Carlos Iribarren, MD, MPH, PhD;
  3. Malini Chandra, MS, MBA;
  4. Phenius V. Lathon;
  5. Stephen P. Fortmann, MD;
  6. Thomas Quertermous, MD;
  7. Mark A. Hlatky, MD; and
  8. for the Atherosclerotic Disease, Vascular Function and Genetic Epidemiology (ADVANCE) Study
  1. From Kaiser Permanente of Northern California, Oakland, California; University of California, San Francisco, San Francisco, California; and Stanford University School of Medicine, Stanford, California.

    Abstract

    Background: Coronary atherosclerosis develops slowly over decades but is frequently characterized clinically by sudden unstable episodes. Patients who present with unstable coronary disease, such as acute myocardial infarction, may systematically differ from patients who present with relatively stable coronary disease, such as exertional angina.

    Objective: To examine whether medication use or patient characteristics influence the mode of initial clinical presentation of coronary disease.

    Design: Case–control study.

    Setting: Large integrated health care delivery system in northern California.

    Patients: Adults whose first clinical presentation of coronary disease was either acute myocardial infarction (n = 916) or stable exertional angina (n = 468).

    Measurements: Use of cardiac medications before the event from pharmacy databases and demographic, lifestyle, and clinical characteristics from self-report and clinical and administrative databases.

    Results: Compared with patients with incident stable exertional angina, patients with incident acute myocardial infarction were more likely to be men, smokers, physically inactive, and hypertensive but were less likely to have a parental history of coronary disease. Patients presenting with myocardial infarction were much less likely to have received statins (19.3% vs. 40.4%; P < 0.001) and β-blockers (19.0% vs. 47.7%; P < 0.001) than patients presenting with exertional angina. After adjustment for potential confounders, recent use of statins (adjusted odds ratio, 0.45 [95% CI, 0.32 to 0.62]) and β-blockers (adjusted odds ratio, 0.26 [CI, 0.19 to 0.35]) was associated with lower likelihoods of presenting with an acute myocardial infarction than with stable angina.

    Limitations: This observational study did not have information on all possible confounding factors, including use of aspirin therapy.

    Conclusion: Statin and β-blocker use was associated with lower odds of presenting with an acute myocardial infarction than with stable angina. Additional studies are needed to confirm that these therapies protect against unstable, higher-risk clinical presentations of coronary disease.

    Article and Author Information

    • Grant Support: By the Donald W. Reynolds Foundation, Las Vegas, Nevada.

    • Potential Financial Conflicts of Interest: None disclosed.

    • Requests for Single Reprints: Alan S. Go, MD, Division of Research, Kaiser Permanente of Northern California, 2000 Broadway Street, 3rd Floor, Oakland, CA 94612-2304; e-mail, Alan.S.Go{at}kp.org.

    • Current Author Addresses: Drs. Go and Iribarren, Ms. Chandra, and Mr. Lathon: Division of Research, Kaiser Permanente of Northern California, 2000 Broadway Street, 3rd Floor, Oakland, CA 94612-2304.

    • Dr. Fortmann: Stanford Medical School, Hoover Pavillion, MD 5705, Stanford, CA 94305-5705.

    • Dr. Quertermous: Stanford University, Falk Building, 300 Pasteur Drive, Stanford, CA 94305.

    • Dr. Hlatky: Stanford University, HRP Redwood Building, Room 150, Stanford, CA 94305.

    • Author Contributions: Conception and design: A.S. Go, C. Iribarren, M. Chandra, S.P. Fortmann, T. Quertermous, M.A. Hlatky.

    • Analysis and interpretation of the data: A.S. Go, C. Iribarren, M. Chandra, P.V. Lathon, S.P. Fortmann, M.A. Hlatky.

    • Drafting of the article: A.S. Go, M. Chandra, M.A. Hlatky.

    • Critical revision of the article for important intellectual content: A.S. Go, C. Iribarren, M. Chandra, P.V. Lathon, S.P. Fortmann, T. Quertermous, M.A. Hlatky.

    • Final approval of the article: A.S. Go, C. Iribarren, M. Chandra, P.V. Lathon, S.P. Fortmann, T. Quertermous, M.A. Hlatky.

    • Provision of study materials or patients: A.S. Go.

    • Statistical expertise: A.S. Go, M. Chandra, M.A. Hlatky.

    • Obtaining of funding: A.S. Go, C. Iribarren, S.P. Fortmann, T. Quertermous, M.A. Hlatky.

    • Administrative, technical, or logistic support: A.S. Go, M. Chandra, P.V. Lathon, T. Quertermous, M.A. Hlatky.

    • Collection and assembly of data: A.S. Go, C. Iribarren, M. Chandra, P.V. Lathon, M.A. Hlatky.

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    1. Ann Intern Med February 21, 2006 vol. 144 no. 4 229-238
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