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Statins and Beta-Blockers May Ease Heart Disease Symptoms

While statins and beta-blockers may not prevent primary heart disease in higher-risk people, they may reduce initially symptoms, according to a study published in the Annals of Internal Medicine and reported by MedPage Today on February 21, 2006.

Investigators Alan S Go, MD, of Kaiser Permanente of Northern California here, and colleagues, found that using statins and beta-blockers to prevent coronary artery disease may mean that initial symptoms may present as angina, instead of a heart attack.

Clinical Trial

The researchers conducted a retrospective case-control study of data from 1,384 people enrolled in Kaiser Permanente of Northern California. Participants showed the first signs of coronary disease in 2001- 2003. A total of 438 had stable exertional angina and 916 had an acute heart attack.

When the investigators compared data from these two groups, they found that the people who had angina were much more likely to have been taking statins, compared with the people who had a heart attack (40% versus 19%), respectively.

Data regarding beta-blockers use followed the same pattern: 48% of the people who experienced were taking beta-blockers, versus only 19% of people who had had heart attacks.

All patients taking these drugs were taking them for primary prevention and not because of any previous coronary artery disease symptoms. (Statins had been prescribed for dyslipidemia, while beta-blockers had been prescribed for hypertension.)

Data analysis showed that the people who had had a heart attack were more likely to be male, physically inactive, smokers and hypertensive. After adjusting for these variables, statin use was associated with a 55% lower risk of heart attack as a first symptom, and beta-blockers were associated with 74% lower risk.

Go et al also analyzed the use of alpha-blockers, ACE inhibitors, angiotensin II receptor blockers and (among women) hormone therapy. However, use of none of these drugs correlated with reduced risk of heart attack.

"Although our findings must be confirmed by randomized studies, they suggest that use of statins and beta-blockers for primary prevention may not only reduce the incidence of coronary artery disease but may also increase the likelihood of more stable, lower-risk clinical presentation of coronary atherosclerosis," the authors wrote.

Interpreting Results

In an accompanying editorial published in the same issue, Sidney C Smith Jr, MD, of the University of North Carolina at Chapel Hill wrote, "This finding may be important, and the authors are appropriately cautious" about interpretation, according to MedPage Today.

"Go and colleagues acknowledge that because their study was not prospective, it lacked information on confounding factors such as the use of aspirin therapy to prevent coronary heart disease," Dr Smith reportedly added.

"If aspirin therapy was strongly associated with the use of statins and beta-blockers, it could explain some of the effect of these two drugs." However, if borne out by randomized trials, "these findings could have a substantial effect on patient care."

Sources:> Drugs to Prevent Heart Disease May Soften its First Symptoms, MedPage Today, February 21, 2006. Statin and beta-blocker therapy and the initial presentation of coronary heart disease. Alan S Go, et al. Annals of Internal Medicine, volume 144(4), pages 229-238, February 21, 2006. Can preventive therapy alter the initial presentation of coronary heart disease? Smith SC, Annals of Internal Medicine, volume 144, pages 296-297, February 21, 2006.

Posted: February 2006