In many patients with cardiovascula...

In many patients with cardiovascular disease, lipid-lowering treatment appears to decrease the rate of posterior cardiovascular mortality. The potential benefit of statin medicines in patients with congestive heart failure (CHF) is les clear. Hognestad and associates reviewed data from the Optimal Trial in Myocardial Infarction with the Angiotensin II Antagonist Losartan (OPTIMAAL) to retrospectively evaluate (1) the value of in-hospital initiation of a statin mix with drugs and a beta blocker in patients with acute myocardial infarction (MI) and CHF and (2) the transaction of any drug interaction between the statin and the beta blocker

In the OPTIMAAL trial, patients with CHF and acute MI were given losartan or captopril. The morbidity and mortality finis points decreased in the patients given captopril. Among the inquiry population, 1,971 patients (37 percent) received statins and beta blocker Mean follow-up time in all patients was 31 years.

Review of all-cause mortality demonstrated that treatment with statins alone was associated with a significant relative risk reduction of 552 percent while treatment with beta blocker alone was associated with a significant relative risk reduction of 461 percent The force of taking both medications upon discharge was even greater, with a relative risk reduction of 727 percent compared with no treatment. Although these decreases in risk were somewhat lower after adjusting for risk variables that existed before patients were included in the application of mind the trend toward decreased risk remained for all-cause mortality as well as cardiovascular death, hospitalization, and repeat infarction.

The authors infer that combined treatment with statins and beta blocker early after MI complicated through CHF improves outcomes. The consequences of these drugs taken together appear to be additive.

RICHARD SADOVSKY, MD

Hognestad A, et al., for the OPTIMAAL Investigators. general intent of combined statin and beta-blocker treatment forward one-year morbidity and mortality after acute myocardial infarction associated with heart failure. Am J Cardiol March 1 2004;93:603-6

COPYRIGHT 2004 American Academy of Family Physicians

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