Denmark: Most patients with known ischemic heart disease (IHD) or previous myocardial infarction (MI) are eligible for additional new preventive techniques, according to a recent study published in the journal JAMA Cardiology. This raises questions for the cardiovascular community and health care communities about access to these potentially expensive therapies, including strategies for prioritizing their use.
Patients with known IHD and MI for decades have been treated with a plethora of preventive therapies including aspirin, P2Y12 inhibitor, β-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and statin therapy. Widespread use of this secondary prevention regimen has been partially responsible for the reduction in cardiovascular mortality in the US. Still, IHD patients face up to 5 to 10% annual risk for recurrent events. This has spurred the development of multiple new therapies including novel antithrombotic regimens, non statin lipid-lowering therapies, anti-inflammatory agents, and cardioprotective antidiabetic agents.
While the emerging CV prevention therapeutics will provide many treatment opportunities for clinicians and their patients, it also raises many questions for contemporary cardiac care. What constitutes the optimal combination of CV prevention therapies? Can such strategies be routinely implemented? If so, will patients be able to afford and durably maintain these regimens?
Martin Bødtker Mortensen, Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark, and colleagues conducted the study to determine the eligibility and preventive potential for these new preventive therapies in a contemporary population.
The study included 6292 patients with known IHD and 2277 with a previous MI enrolled between November 2003 and February 2015. The data were analyzed between January and October 2019.
The researchers determined the drug eligibility and evidence-based potential for preventing major CV events of the 12 cardiovascular drugs tested in the following recent RCTs -- IMPROVE-IT, PEGASUS, EMPA-REG, LEADER, SUSTAIN-6, FOURIER, CANVAS, REVEAL, CANTOS, COMPASS, ODYSSEY-OUTCOMES, and REDUCE-IT.
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Key findings of the study include:
- In patients with IHD or MI at baseline, eligibility for 1 or more new medications was 80% (n = 5036) and 99% (n = 2273), respectively, by meeting RCT enrollment criteria.
- Dividing the new therapies into 4 drug classes (lipid-modifying, antithrombotic, anti-inflammatory, and antidiabetic drugs), 2594 and 1834 patients with IHD or MI (41% and 81%, respectively) were eligible for 2 or more drug classes simultaneously.
- The 5-year estimated percentage of major cardiovascular events that could be prevented for each new therapy was 1% to 20% in patients with IHD or MI at baseline.
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