title: Cardioprotective medication use and risk factor control among US adults with unrecognized myocardial infarction: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.
abstract: BACKGROUND
  Individuals with unrecognized myocardial infarction (UMI) have similar risks for cardiovascular events and mortality as those with recognized myocardial infarction (RMI). The prevalence of cardioprotective medication use and blood pressure and low-density lipoprotein cholesterol control among individuals with UMI is unknown.
  
  
  METHODS
  Participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who were recruited between May 2004 and October 2007 received baseline twelve-lead electrocardiograms (n = 21,036). Myocardial infarction (MI) status was characterized as no MI, UMI (electrocardiogram abnormalities consistent with MI without self-reported history; n = 949; 4.5%), and RMI (self-reported history of MI; n = 1574; 7.5%).
  
  
  RESULTS
  For participants with no MI, UMI, and RMI, prevalence of use was 38.4%, 44.4%, and 75.7% for aspirin; 18.0%, 25.8%, and 57.2% for beta blockers; 31.7%, 38.7%, and 55.0% for angiotensin converting enzyme inhibitors or angiotensin receptor blockers; and 28.1%, 33.9%, and 64.1% for statins, respectively. Participants with RMI were 35% more likely to have low-density lipoprotein cholesterol < 100 mg/dL than participants with UMI (prevalence ratio = 1.35, 95% confidence interval 1.19-1.52). Blood pressure control (,140/90 mmHg) was similar between RMI and UMI groups (prevalence ratio = 1.03, 95% confidence interval 0.93-1.13).
  
  
  CONCLUSIONS
  Although participants with UMI were somewhat more likely to use cardioprotective medications than those with no MI, they were less likely to use cardioprotective medications and to have controlled low-density lipoprotein cholesterol than participants with RMI. Increasing appropriate treatment and risk factor control among individuals with UMI may reduce risk of mortality and future cardiovascular events.
authors: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294-0022, USA. elevitan@uab.edu
authors: Emily B
authors: EB
authors: Levitan
authors: Christopher
authors: C
authors: Gamboa
authors: Monika M
authors: MM
authors: Safford
authors: Dana V
authors: DV
authors: Rizk
authors: Todd M
authors: TM
authors: Brown
authors: Elsayed Z
authors: EZ
authors: Soliman
authors: Paul
authors: P
authors: Muntner
mesh_terms: D001741:Black or African American; D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D017723:Drug Utilization Review; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality; D010818:Practice Patterns, Physicians'; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000208:ethnology*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People
chemical_list: D002317:Cardiovascular Agents
keywords: risk factor control; secondary prevention; unrecognized myocardial infarction
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