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Statins, antiplatelets, RAAS inhibitors tied to mortality benefit after CABG: SWEDEHEART
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PARIS — New data from the SWEDEHEART registry presented at the European Society of Cardiology Congress show that use of statins, antiplatelet therapies and renin-angiotensin-aldosterone system inhibitors yields reduced risk for mortality after CABG.
However, the researchers found no mortality benefit from beta-blockers in this population, and noted that adherence to the beneficial medications was high shortly after surgery but tapered over time.
The objective was to determine the frequency of dispensed prescriptions for statins, antiplatelet therapies, beta-blockers and renin-angiotensin-aldosterone system (RAAS) inhibitors after CABG, and to determine associations between longitudinal use of these medications and long-term mortality, Erik Björklund, MD, from Sahlgrenska Academy, Gothenburg, Sweden, said during a press conference.
The researchers evaluated 28,812 patients (mean age, 67 years; 80% men) who underwent isolated first-time CABG between 2006 and 2015 who were listed in the Swedish Cardiac Surgery registry, part of the SWEDEHEART registry. The median follow-up was 4.9 years.
At 6 months after discharge, 93.9% of patients had been dispensed statins, 91% had been dispensed beta-blockers, 72.9% had been dispensed RAAS inhibitors and 93% had been dispensed antiplatelet therapies, but over 8 years, use of all four medication classes declined, according to the researchers.
“The biggest decline occurred during the first year of follow-up,” Björklund said during a press conference. “There were no known major differences in the use of medications between men and women. Patients aged 75 years and older received less secondary prevention medications than younger patients.”
The rate of dispensed prescriptions at baseline rose for statins, beta-blockers and RAAS inhibitors between 2006 and 2015 (P < .001 for all), Björklund and colleagues found.
“There was actually a 1% decrease (from 93.2% to 92.2%) in the rate of dispensed prescriptions of platelet inhibitors from 2006 to 2015 (P = .004),” Björklund told Healio. “Given the large number of observations, this small difference turned out statistically significant, but we do not think this represents a relevant change in practice.”
During the study period, patients taking statins had reduced risk for mortality (adjusted HR = 0.56; 95% CI, 0.52-0.6), as did patients taking antiplatelet therapies (aHR = 0.74; 95% CI, 0.69-0.81) and RAAS inhibitors (aHR = 0.78; 95% CI, 0.73-0.84), but the same was not true for patients taking beta-blockers (aHR = 0.97; 95% CI, 0.9-1.06), Björklund said, noting that results did not vary by age.
“This study supports recommendations in guidelines for the use of statins, RAAS inhibitors and antiplatelets,” Björklund said during the press conference. “It underlines the importance of continuous treatment. This study provides no support for routine long-term use of beta-blockers after CABG. We also believe it encourages use of secondary prevention medications in patients aged 75 years and over.” – by Erik Swain
Reference:
Björklund E, et al. Hot Line Session 5. Presented at: European Society of Cardiology Congress; Aug. 31-Sept. 4, 2019; Paris.
Disclosure: Björklund reports no relevant financial disclosures.
Editor’s Note: This article was updated on Sept. 9, 2019 to clarify that the study measured dispensed prescriptions and to correct data on dispensed prescriptions of platelet inhibitors.