For patients with undiagnosed heart disease, taking medications known as statins and beta-blockers may mean the difference between suffering a heart attack as a first symptom versus experiencing mild chest pain.
New research from the Stanford University School of Medicine suggests that these preventive drugs can steer patients away from having a heart attack toward the less serious symptom of mild chest pain that occurs only with exercise (angina) even if they don't stop the build-up of cholesterol in a patient's arteries. The study, to be published in the Feb. 21 issue of the Annals of Internal Medicine, was conducted with investigators at Kaiser Permanente Division of Research in Oakland and the University of California-San Francisco.
"That's the scary thing about heart disease," said senior author Mark Hlatky, MD, professor of health research and policy and of cardiovascular medicine at Stanford. "You can be fine one minute and dead the next. You can put up with a little chest pain every once in a while if you know you're not about to die from it."
Researchers for the study wanted to know how doctors could help reduce a patient's risk of having a heart attack as a first symptom even if medications for high blood pressure or high cholesterol were unsuccessful in stopping the onset of heart disease. Statins are typically prescribed to reduce cholesterol, one of the warning signs for heart disease. Beta-blockers are given to patients with high blood pressure, another warning sign for heart disease.
"While doctors try to prevent coronary disease by treating high blood pressure and high cholesterol, it's not 100 percent effective," Hlatky said. "If there are warning symptoms like angina with exercise, there is enough time to see a doctor and get started on effective treatments that reduce risk. Having a heart attack causes permanent damage, even if it doesn't kill you."
Researchers evaluated 1,400 patients enrolled within Kaiser Permanente of Northern California between the years 2001-03. Of those patients, only 20 percent who had suffered a heart attack were on a statin, compared with 40 percent of patients who presented with exertional angina.
The patients who suffered a heart attack "out of the blue" were much less likely than those who had only angina to be taking statins and beta-blockers. Patients on statins reduced the risk of heart attack by more than half.
"We looked at all the medications used to prevent heart disease," said Alan Go, MD, of Kaiser Permanente of Northern California's division of research and lead author of the study. "But only statins and beta-blockers lowered the risk of heart attack." The study also looked at use of alpha-blockers, ACE inhibitors or angiotensin II receptor blockers and, among women, of hormone therapy. None of these treatments showed a similar correlation with a lower risk of heart attack.
"The results were really quite striking," said Hlatky. "These drugs were quite effective in reducing risks of having a heart attack as the first symptom of coronary artery disease."
The other Stanford authors of the study are Thomas Quertermous, MD, the William G. Irwin Professor in Cardiovascular Medicine, and Stephen P. Fortmann, MD, the C.F. Rehnborg Professor in Disease Prevention.
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