Go Alan S, Iribarren Carlos, Chandra Malini, Lathon Phenius V, Fortmann Stephen P, Quertermous Thomas, Hlatky Mark A
Division of Research, Kaiser Permanente of Northern California, Oakland, California 94612-2304, USA.
Ann Intern Med. 2006 Feb 21;144(4):229-38. doi: 10.7326/0003-4819-144-4-200602210-00004.
Coronary atherosclerosis develops slowly over decades but is frequently characterized clinically by sudden unstable episodes. Patients who present with unstable coronary disease, such as acute myocardial infarction, may systematically differ from patients who present with relatively stable coronary disease, such as exertional angina.
To examine whether medication use or patient characteristics influence the mode of initial clinical presentation of coronary disease.
Case-control study.
Large integrated health care delivery system in northern California.
Adults whose first clinical presentation of coronary disease was either acute myocardial infarction (n = 916) or stable exertional angina (n = 468).
Use of cardiac medications before the event from pharmacy databases and demographic, lifestyle, and clinical characteristics from self-report and clinical and administrative databases.
Compared with patients with incident stable exertional angina, patients with incident acute myocardial infarction were more likely to be men, smokers, physically inactive, and hypertensive but were less likely to have a parental history of coronary disease. Patients presenting with myocardial infarction were much less likely to have received statins (19.3% vs. 40.4%; P < 0.001) and beta-blockers (19.0% vs. 47.7%; P < 0.001) than patients presenting with exertional angina. After adjustment for potential confounders, recent use of statins (adjusted odds ratio, 0.45 [95% CI, 0.32 to 0.62]) and beta-blockers (adjusted odds ratio, 0.26 [CI, 0.19 to 0.35]) was associated with lower likelihoods of presenting with an acute myocardial infarction than with stable angina.
This observational study did not have information on all possible confounding factors, including use of aspirin therapy.
Statin and beta-blocker use was associated with lower odds of presenting with an acute myocardial infarction than with stable angina. Additional studies are needed to confirm that these therapies protect against unstable, higher-risk clinical presentations of coronary disease.
冠状动脉粥样硬化在数十年间缓慢发展，但临床上常以突发不稳定事件为特征。表现为不稳定型冠心病的患者，如急性心肌梗死患者，可能在系统层面上与表现为相对稳定型冠心病的患者，如劳力性心绞痛患者有所不同。
探讨药物使用或患者特征是否会影响冠心病的初始临床表现模式。
病例对照研究。
加利福尼亚北部的大型综合医疗服务提供系统。
首次临床表现为冠心病的成年人，其中急性心肌梗死患者916例，稳定劳力性心绞痛患者468例。
事件发生前从药房数据库获取的心脏药物使用情况，以及通过自我报告和临床及管理数据库获取的人口统计学、生活方式和临床特征。
与新发稳定劳力性心绞痛患者相比，新发急性心肌梗死患者更可能为男性、吸烟者、缺乏体力活动且患有高血压，但有冠心病家族史的可能性较小。与劳力性心绞痛患者相比，心肌梗死患者接受他汀类药物治疗（19.3% 对 40.4%；P < 0.001）和β受体阻滞剂治疗（19.0% 对 47.7%；P < 0.001）的可能性要低得多。在对潜在混杂因素进行调整后，近期使用他汀类药物（调整后的优势比，0.45 [95% CI，0.32 至 0.62]）和β受体阻滞剂（调整后的优势比，0.26 [CI，0.19 至 0.35]）与急性心肌梗死相比稳定型心绞痛的发生可能性较低相关。
这项观察性研究没有关于所有可能混杂因素的信息，包括阿司匹林治疗的使用情况。
使用他汀类药物和β受体阻滞剂与急性心肌梗死相比稳定型心绞痛的发生几率较低相关。需要进一步研究来证实这些治疗方法可预防冠心病不稳定、高风险的临床表现。
