Cor Vasa 2006, 48(4):135-141 | DOI: 10.33678/cor.2006.046

Current status of cardiovascular pharmacotherapy in patients after myocardial infarction and/or revascularization in the Czech Republic in 2005. Developments seen during the past 5 and 10 years

Jiří Widimský^1,*, Pavel Vaněk², František Juráň³, Věra Lánská⁴

¹ Klinika kardiologie, Institut klinické a experimentální medicíny, Praha

² Konstantinovy Lázně

³ Lázně Teplice nad Bečvou

⁴ Statistické oddělení, Institut klinické a experimentální medicíny, Praha, Česká republika

Aim:
To provide an overview of the status of cardiovascular pharmacotherapy in patients after myocardial infarction and/or myocardial revascularization in the Czech Republic in 2005 and to compare it with that in 1999-2000 and in 1995, and thus to evaluate the progress in drug treatment over the last 5 and 10 years.

Method:
Using medical report-based questionnaires, the authors sought to monitor the status of cardiovascular pharmacotherapy in 614 myocardial infarction survivors and 243 patients after revascularization for coronary heart disease without a myocardial infarction.

Results:
The proportion of patients treated with lipid-lowering drugs rose significantly and markedly (88.1% vs. 47.8% in 1999-2000 and vs. 12.5% in 1995; p < 0.001). The absolute majority of patients were treated with statins (85.3%). Mean lipid levels when starting spa therapy were 4.6 ± 1.0 mmol/L for total cholesterol (TC); 2.6 ± 0.9 mmol/L for LDL-cholesterol (LDL-C); 1.8 ± 0.9 mmol/L for triglycerides (TG), and 1.21 ± 0.33 for HDL-cholesterol (HDL-C). The proportion of patients with TC < 5.2 mmol/L rose from 15-21% in 1995 to 47% in 1999-2000 and to 80.7% in 2005; 52.8% of patients had LDL-C levels below 2.5 mmol/L, with another 23.7% showing LDL-C levels of 2.5-3.0 mmol/L. However, we also observed a significant decrease in mean TC and TG levels in patients not treated with lipid-lowering drugs.
While beta-blockers were used to treat only 59.4% of patients in 1995, the figure rose to 79.6% in 1999 (p < 0.01) and to 87.0% in 2005 (p < 0.001). Unlike the situation in 1999-2000, lower beta-blocker use in patients with systolic left ventricular dysfunction was no longer seen. Also, unlike the situation in 1999-2000, the rates of lipid-lowering drug and ACE inhibitor use in patients aged over 70 were not lower in 2005. The proportion of patients receiving ACE inhibitors also increased, to 63.8 % in 2005 from 44.7% in 1999 (p < 0.001) and from 30.3% in 1995 (p < 0.01). These data document the marked improvement in cardiovascular pharmacotherapy, which will undoubtely have a beneficial impact on CHD morbidity and mortality rates. The comparison with the status of cardiovascular pharmacotherapy five years and, even more so, 10 years ago, clearly documents the advances made in the drug treatment of patients after myocardial infarction.

Conclusions:
The last 5-6 years have witnessed further marked and significant progress in cardiovascular pharmaco-therapy in patients after myocardial infarction and/or myocardial revascularization. The rates of statin, beta-blocker and ACE inhibitor use have increased notably. There has been an appreciable rise in the proportion of patients with TC levels < 5.2 mmol/L. Conversely, TC levels decreased significantly even in patients not receiving lipid-lowering drugs. Still, some shortcomings do persist. Although lipid-lowering drugs are currently received by close to 90% of patients, target LDL-C levels are not reached in more than 50%. Overweight and obesity still persist with a high frequency. Hypertension control is likewise not sufficiently effective. However, when assessing the current status of cardiovascular pharmaco-therapy in patients after myocardial infarction and/or revascularization in the Czech Republic within the European
context, this country is certainly one showing remarkable progress in this field.

Keywords: Cardiovascular pharmacotherapy; Secondary prevention after myocardial infarction; Czech Republic

Published: April 1, 2006  Show citation