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Long-term impact of secondary preventive treatments in patients with stable angina

  • CARDIOVASCULAR DISEASE
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

We assessed the independent effects of beta blockers, calcium antagonists, lipid-lowering drugs, angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), anti-platelet drugs, vitamin K antagonists, percutaneous coronary intervention (PCI) and coronary artery by-pass grafting (CABG) on mortality and on the composite endpoint of death, myocardial infarction, stroke or heart failure in patients with stable angina pectoris. We estimated the effects of the interventions used at baseline by multivariate Cox regression and during follow-up by G-estimation in 7,665 patients followed for a mean of 5 years in the ACTION trial. Adjusted hazard ratios (95% confidence intervals) comparing all cause mortality among users during follow-up to non-users were 1.01 (0.91, 1.09) for beta blockade, 0.82 (0.75, 0.89) for ACEIs or ARBs, 0.93 (0.87, 0.98) for calcium antagonists, 0.54 (0.49, 0.62) for lipid-lowering drugs, 0.49 (0.42, 0.53) for anti-platelet drugs, 0.74 (0.69, 0.78) for PCI, and 0.91 (0.82, 0.98) for CABG. Effects on the composite endpoint were less marked. This observational study confirms that ACEIs or ARBs, lipid-lowering and anti-platelet drugs as used in the everyday management of stable angina have independent secondary preventive effects. Calcium antagonists, PCI and CABG also appear to improve outcome.

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Abbreviations

ACEI:

Angiotensin converting enzyme inhibitor

aHR:

Adjusted hazard ratio

ARB:

Angiotensin receptor blocker

ATC:

Anatomical therapeutic chemical

CABG:

Coronary artery by-pass grafting

CEC:

Critical events committee

CI:

Confidence interval

GCP:

Good clinical practice

GITS:

Gastrointestinal therapeutic system

HF:

Heart failure

HR:

Hazard ratio

ICH:

International conference on harmonisation

MI:

Myocardial infarction

PCI:

Percutaneous coronary intervention

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Acknowledgments

The contribution of investigators, committee members and other study personnel as listed elsewhere is gratefully acknowledged [2], as is the support of Bayer Healthcare AG. Bayer Healthcare AG had no role in the design and conduct of the study; or in the preparation, review and approval of this manuscript.

Conflict of interest

The ACTION trial was funded by Bayer Healthcare AG. S de Brouwer, B-A Kirwan, and J Lubsen were full-time employees of SOCAR Research SA, which managed the study. Z Vokó worked as consultant epidemiologist for SOCAR Research SA. PHJM Dunselman was member of the Critical Events Committee and Nicolas Danchin was Chairman of this committee. JE Otterstad was member of the Steering Committee and one of the country coordinators. Members of committees were funded by SOCAR Research SA to attend meetings related to the trial. Z Vokó, N Danchin, JE Otterstad, PHJM Dunselman, J Lubsen have served as consultants to or received travel expenses, or funding for research from other pharmaceutical companies.

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Authors and Affiliations

  1. Department of Health Policy & Health Economics, Institute of Economics, Faculty of Social Sciences, Eötvös Loránd University, Pázmány Péter sétány 1/a, H-1117, Budapest, Hungary

    Zoltán Vokó

  2. SOCAR Research, Nyon, Switzerland

    Sophie de Brouwer, Jacobus Lubsen & Bridget-Anne Kirwan

  3. Hôpital Européen Georges Pompidou, Paris, France

    Nicolas Danchin

  4. Division of Cardiology, Vestfold Hospital, Toensberg, Norway

    Jan-Erik Otterstad

  5. Amphia Ziekenhuis, Breda, The Netherlands

    Peter H. J. M. Dunselman

  6. Department of Epidemiology and Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands

    Jacobus Lubsen

Authors
  1. Zoltán Vokó
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  2. Sophie de Brouwer
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  3. Jacobus Lubsen
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  4. Nicolas Danchin
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  5. Jan-Erik Otterstad
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  6. Peter H. J. M. Dunselman
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  7. Bridget-Anne Kirwan
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Correspondence to Zoltán Vokó.

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Vokó, Z., de Brouwer, S., Lubsen, J. et al. Long-term impact of secondary preventive treatments in patients with stable angina. Eur J Epidemiol 26, 375–383 (2011). https://doi.org/10.1007/s10654-011-9558-5

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  • DOI: https://doi.org/10.1007/s10654-011-9558-5

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