title: Long-term, continuous treatment with both oral and transdermal nitrates increases cardiac events in healed myocardial infarction patients.
abstract: This study was performed to investigate the effects of continuous dosing of oral, transdermal (patch), and a combination of the two with nitrate treatments on cardiac events in patients with healed myocardial infarction. In total, 1,291 patients with healed myocardial infarction were assigned 2 groups: treatment with nitrates (n=713) or nontreatment (n=578). Nitrate treatment was subdivided into 3 groups: patch group (n=149), oral group (n=504), and combination group (n=60). The mean observation period was 17.4 +/- 21.1 months. Primary end points were nonfatal and fatal recurrent myocardial infarction, death from congestive heart failure, and sudden death. Baseline characteristics were also compared among the 4 groups to determine any effects on outcome. Among the patients with patch, oral, and combination groups, cardiac events occurred 3.4%, 6.7%, 10.0%, respectively, whereas only 2.9% of the patients treated without nitrates had cardiac events. The incidence of cardiac events was significantly greater in patients with oral nitrates and combination groups compared to patients without nitrates (p<0.01, respectively). Continuous dosing of long-term treatment with both oral and transdermal nitrates increased cardiac events in healed myocardial infarction patients.
authors.affiliation: First Department of Internal Medicine, Kinki University School of Medicine, Osaka, Japan. kanamasa@med.kindai.ac.jp
authors.forename: Ken
authors.initials: K
authors.lastname: Kanamasa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hayashi
authors.forename: Akio
authors.initials: A
authors.lastname: Kimura
authors.forename: Akiko
authors.initials: A
authors.lastname: Ikeda
authors.forename: Kinji
authors.initials: K
authors.lastname: Ishikawa
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D009566:Nitrates / Q000008:administration & dosage* / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D009566:Nitrates