Investigation of the Therapeutic Potential of Organic Nitrates in Mortality Reduction Following Acute Myocardial Infarction in Hyperlipidemia Patients: A Population-Based Cohort Study

TL;DR

This study finds that using organic nitrates in treating heart attack patients with high cholesterol significantly reduces mortality, especially when combined with diuretics.

Contribution

The study identifies organic nitrates as a novel effective treatment for improving survival in hyperlipidemia patients with acute myocardial infarction.

Findings

Hyperlipidemia patients aged 61–70 years had the highest proportion in the study cohort.

Organic nitrates were associated with significantly lower all-cause mortality in AMI patients.

Combining organic nitrates with diuretics or beta-blockers improved survival outcomes.

Abstract

Background: Dyslipidemia is a known risk factor for cardiac dysfunction, and lipid-lowering therapy with statins reduces symptoms and reduces hospitalization related to left ventricular heart failure. Acute myocardial infarction (AMI) is a cause of morbidity and mortality worldwide. In this study, we aimed to determine the real-world AMI treatment drug combination used in Taiwan by using the NHI database to understand the treatment outcomes of current clinical medications prescribed for hyperlipidemia patients with AMI. Methods: Using the NHI Research Database (NHIRD), we conducted a retrospective cohort study that compared different treatments for AMI in hyperlipidemia patients in the period from 2016 to 2018. We compared the survival outcomes between those treated with and without organic nitrates in this cohort. Results: We determined that most hyperlipidemia patients were aged 61–70 y (29.95–31.46% from 2016 to 2018), and the annual AMI risk in these patients was <1% (0.42–0.68% from 2016 to 2018). The majority of hyperlipidemia patients with AMI were women, and 25.64% were aged 61–70 y. Receiving organic nitrates was associated with lower all-cause mortality rates (HR, 95% CI, p-value = 0.714, 0.674–0.756, p < 0.0001). After multivariate analysis, the overall survival in four groups (beta-blockers, beta-blocker + diuretics, diuretics, and others) receiving an organic nitrate treatment was significantly higher than in the groups that were not treated with organic nitrates (beta-blockers HR = 0.536, beta-blocker + diuretics HR = 0.620, diuretics HR = 0.715, and others HR = 0.690). Conclusions: The survival benefit was significantly greater in patients treated with organic nitrates than in those treated without organic nitrates, especially when combined with diuretics. A combination of organic nitrates could be a better treatment option for hyperlipidemia patients with AMI.

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