Effect of beta blockers alone, of angiotensin-converting enzyme inhibitors alone, and of beta blockers plus angiotensin-converting enzyme inhibitors on new coronary events and on congestive heart failure in older persons with healed myocardial infarcts and asymptomatic left ventricular systolic dysfunction

Abstract

Persons with asymptomatic left ventricular (LV) systolic dysfunction after myocardial infarction treated with blockers 1,2 or with angiotensin-converting enzyme (ACE) inhibitors 3,4 have a significant reduction in cardiovascular morbidity and mortality. The combined use of blockers plus ACE inhibitors in these persons causes a significantly greater reduction in cardiovascular morbidity and mortality. 5,6 We are reporting data from an observational study investigating the effects of the use of blockers alone, ACE inhibitors alone, and of combined blockers plus ACE inhibitors on the incidences of new coronary events and of congestive heart failure (CHF) in older asymptomatic persons with prior myocardial infarction and LV ejection fraction 40%. One hundred ninety-six men and 281 women, mean age 79 8 years (range 60 to 96), with prior myocardial infarction and asymptomatic LV systolic dysfunction with a LV ejection fraction 40% were followed prospectively in a long-term health care facility for the incidences of new coronary events and CHF. The full-time staff physicians taking care of the 477 persons treated 107 of them (22%) with blockers alone, 89 (19%) with ACE inhibitors alone, 132 (28%) with both blockers plus ACE inhibitors, and 149 (31%) with no blocker or ACE inhibitor. Physician use of drugs determined whether blockers, ACE inhibitors, blockers plus ACE inhibitors, or no blockers or ACE inhibitors were administered. Persons were considered to have prior myocardial infarction if they had a documented clinical history of myocardial infarction or electrocardiographic evidence of Q-wave myocardial infarction. New coronary events were diagnosed if the person developed nonfatal or fatal myocardial infarction 7 or sudden coronary death 8 as previously described.