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Late-Breaking Science: Are cardiovascular medications actually improving outcomes in real life?

Yes, appears to be the answer according to two Late-Breaking Science in Coronary Artery Disease presentations from researchers at the Department of Cardiology, Aarhus University, Denmark.

Pharmacology and Pharmacotherapy
Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care

In the first presentation, Doctor Kevin Kris Warnakula Olesen described an analysis to determine if new pharmacological treatments plus stricter treatment targets and refined invasive diagnostic and revascularisation techniques have affected the risk of cardiovascular (CV) events in patients with stable angina. All 29,471 patients with stable angina pectoris examined by coronary angiography in Western Denmark from 2004 to 2016 were included.

Patients with previous myocardial infarction (MI), percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and patients without coronary artery disease were excluded. Two­-year cumulative incidence data were calculated for MI, PCI, CABG, ischaemic stroke and all­-cause mortality using data from national health registries.

When data from 2004–2006 were compared with 2013–2016, the prevalence of patients diagnosed with obstructive three­-vessel disease decreased (from 33.3% to 17.2%), while the number of patients with nonobstructive, multi­vessel disease increased (from 6.2% to 26.2%). Of note, when comparing 2004–2006 with 2013–2016, 2­-year risk was reduced for MI (by 35%), PCI (by 28%), CABG (by 34%), ischaemic stroke (by 52%) and all­-cause mortality (by 35%).

In the second presentation, Doctor Christine Gyldenkerne described how the use of prophylactic CV medications has increased over the last two decades in patients with type 2 diabetes mellitus (T2DM) in recognition of their high CV disease (CVD) risk. However, she noted that there was sparse evidence about whether preventative measures were actually reducing the risk of MI and death in real-life patients.

To find out, Dr. Gyldenkerne and team conducted an analysis to identify all patients with newly diagnosed T2DM and with no previous CVD in Denmark from 1996 to 2011. All 211,278 patients were matched 1:5 on age and sex with people without T2DM or CVD from the general population. Using data from national health registries, all participants were followed for 7 years and trends in MI and all-cause mortality were examined. The relationship between redemption of prescriptions for prophylactic CV medications within ± 1 year of diagnosis and outcomes was also assessed.

Comparing the periods 1996–1999 to 2008–2011, the researchers found that patients with newly diagnosed T2DM and no previous CVD experienced major reductions in the risk of MI and death. Between 1996–1999 and 2008–2011, the 7-year relative risk was reduced by 61% for MI and by 41% for death. During the same period, the absolute risks of MI and death were reduced by 4% and 12%, respectively. When comparing patients with diabetes to the general population, the initial large differences in risk narrowed over time. By the end of the study, the risk of MI among patients with diabetes was only marginally higher – by 0.6% – than in the general population.

In those with diabetes, use of cholesterol-lowering medications increased more than 10-fold, aspirin increased by 50%, and blood pressure-lowering medications increased up to four times during the study period.

Combined, the two studies show major risk reductions in patients with stable angina and T2DM over the last decades. Although causation cannot be assumed due to the observational nature of these analyses, their findings do appear to show that the use of improved prevention or management strategies over the past two decades have played an important role. 

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.