Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2008 Sep;3(5):1415-22.
doi: 10.2215/CJN.02010408. Epub 2008 Jul 9.

Associations of kidney function with cardiovascular medication use after myocardial infarction

Wolfgang C Winkelmayer  1 , Raisa Levin, Soko Setoguchi
Affiliations
Comparative Study

Associations of kidney function with cardiovascular medication use after myocardial infarction

Wolfgang C Winkelmayer et al. Clin J Am Soc Nephrol. 2008 Sep.

Abstract

Background and objectives: It is unknown whether adherence to recommended medications after myocardial infarction (MI) differs by kidney function.

Design, setting, participants, & measurements: This was a retrospective cohort study of older patients who were discharged after MI in two Eastern states between 1995 and 2004. Patients were categorized as having ESRD, having chronic kidney disease (CKD), and being free from diagnosed CKD. Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB), beta blockers (BB), and statins was assessed within 30 d after discharge. Good adherence was defined as proportion of days covered >80% during the first year after discharge.

Results: Compared with patients with no CKD, patients with CKD had 22% lower adjusted use of ACEI/ARB but similar rates of BB and statin use. Patients with ESRD experienced 43% lower ACEI/ARB and 17% lower statin use. Only 64% (BB), 57% (statins), and 54% (ACEI/ARB) of patients had good 1-yr adherence. Adherence was similar between patients with CKD and with no CKD for all study drugs. Fewer patients with ESRD had good adherence to BB.

Conclusions: With the exception of lower ACEI/ARB use in patients with CKD, we found no differences between patients with CKD and with no CKD in their use of and adherence to these cardiovascular medications after MI. Patients with ESRD experienced lower use of ACEI/ARB and statins and lower adherence to BB regimens. Postulated differences in medication use after MI across levels of kidney function are unlikely to explain the observed differences in long-term outcomes.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Use of recommended medications within 30 d after discharge for myocardial infarction (MI), by level of kidney function. The outcome was any filled prescription of the study drug within 30 d after discharge from hospitalization for MI. Shown are proportions and corresponding 95% confidence intervals (CI). ACE, angiotensin-converting enzyme; ARB, angiotensin II receptor blocker; CKD, chronic kidney disease; noCKD, patient free from diagnosed CKD.
Figure 2.
Figure 2.
Temporal trends in medication use after MI, by level of kidney function. Medication use within 30 d after discharge from hospitalization for MI. (A) ACE inhibitors or ARB. (B) β Blockers. (C) Statins.
Figure 3.
Figure 3.
Proportion of patients with good adherence to recommended medications in the year after discharge for MI. The outcome was percentage of days covered ≥80% for each study drug during the first year after discharge from hospitalization for MI, among those who filled a prescription for the study drug with 30 d of discharge. Shown are proportions and corresponding 95% CI.
Figure 4.
Figure 4.
Temporal trends in good adherence to recommended medications in the year after discharge for MI. Proportion of patients with good adherence as indicated by a proportion of days covered >80% during the year after discharge from hospitalization for MI. (A) ACE inhibitors or ARB. (B) β Blockers. (C) Statins.
See this image and copyright information in PMC

References

    1. Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, Van Lente F, Levey AS: Prevalence of chronic kidney disease in the United States. JAMA 298 :2038 –2047,2007 - PubMed
    1. Collins AJ, Foley R, Herzog C, Chavers B, Gilbertson D, Ishani A, Kasiske B, Liu J, Mau LW, McBean M, Murray A, St Peter W, Xue J, Fan Q, Guo H, Li Q, Li S, Li S, Peng Y, Qiu Y, Roberts T, Skeans M, Snyder J, Solid C, Wang C, Weinhandl E, Zaun D, Zhang R, Arko C, Chen SC, Dalleska F, Daniels F, Dunning S, Ebben J, Frazier E, Hanzlik C, Johnson R, Sheets D, Wang X, Forrest B, Constantini E, Everson S, Eggers P, Agodoa L: Excerpts from the United States Renal Data System 2007 Annual Data Report. Am J Kidney Dis 51 :S1 –S320,2008 - PubMed
    1. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351 :1296 –1305,2004 - PubMed
    1. Shlipak MG, Heidenreich PA, Noguchi H, Chertow GM, Browner WS, McClellan MB: Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients. Ann Intern Med 137 :555 –562,2002 - PubMed
    1. Wright RS, Reeder GS, Herzog CA, Albright RC, Williams BA, Dvorak DL, Miller WL, Murphy JG, Kopecky SL, Jaffe AS: Acute myocardial infarction and renal dysfunction: A high-risk combination. Ann Intern Med 137 :563 –570,2002 - PubMed

Publication types

MeSH terms

Substances