Cardiovascular Medication Use Before First Myocardial Infarction

London School of Hygiene and Tropical Medicine17,000 enrolled

Overview

Large randomised trials have shown that cardiovascular medications prescribed to patients at high cardiovascular risk are effective in reducing the incidence of cardiovascular events. Their use is recommended in the United Kingdom and international guidelines (e.g. the National Institute of Clinical Excellence). However, these medications do not prevent cardiovascular events in all patients and there is now a body of research investigating the effects of cardiovascular medications on outcomes in myocardial infarction (MI), including clinical presentation, infarct size and post-MI mortality. However, the independent effects of cardiovascular drugs on post-MI all cause mortality are unclear, and there are limitations to many of the published studies in terms of their cardiovascular drug exposure data. This project utilizes prospectively collected data on cardiovascular drug use, and links to MI data from hospital and mortality records.

Study Type

OBSERVATIONAL

Enrollment

17,000

Conditions

Myocardial Infarction

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: Patients in GPRD practices which are deemed "up to standard" by GPRD criteria will be included if their practice agreed to be linked to the Myocardial Ischaemic National Audit Project (MINAP), Hospital Episode Statistics (HES) and Office for National Statistics (ONS) datasets. Patients must have at least one year of GPRD "up to standard" registration before the date of first myocardial infarction. Age over 18. First myocardial infarction occurring between 1st January 2003 and 31st December 2008, as recorded in the HES data or MINAP. Exclusion Criteria: Patients will be excluded if they do not fulfil one of the inclusion criteria.

Outcomes

Primary Outcomes

All cause mortality

All cause mortality, using Office for National Statistics (ONS) mortality statistics

Time frame: Up to seven years

Re-infarction

Reinfarction will be measured based on data from the General Practice Research Database (GPRD), Hospital Episode Statistics (HES), the Myocardial Ischaemia National Audit Project (MINAP) and Office for National Statistics (ONS) mortality data.

Time frame: One year after initial myocardial infarction

Secondary Outcomes

Myocardial infarciton (MI) type

Diagnosed ST-elevation MI or non ST-elevation myocardial infarction

Time frame: Measured at baseline