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Am Fam Physician. 2004;70(9):1774-1776

In many patients with cardiovascular disease, lipid-lowering treatment appears to decrease the rate of subsequent cardiovascular mortality. The potential benefit of statin drugs in patients with congestive heart failure (CHF) is less clear. Hognestad and associates reviewed data from the Optimal Trial in Myocardial Infarction with the Angiotensin II Antagonist Losartan (OPTIMAAL) to retrospectively evaluate (1) the value of in-hospital initiation of a statin drug and a beta blocker in patients with acute myocardial infarction (MI) and CHF, and (2) the occurrence of any drug interaction between the statin and the beta blocker.

In the OPTIMAAL trial, patients with CHF and acute MI were given losartan or captopril. The morbidity and mortality end points decreased in the patients given captopril. Among the study population, 1,971 patients (37 percent) received statins and beta blockers. Mean follow-up time in all patients was 3.1 years.

Review of all-cause mortality demonstrated that treatment with statins alone was associated with a significant relative risk reduction of 55.2 percent, while treatment with beta blockers alone was associated with a significant relative risk reduction of 46.1 percent. The effect of taking both medications on discharge was even greater, with a relative risk reduction of 72.7 percent compared with no treatment. Although these decreases in risk were somewhat lower after adjusting for risk variables that existed before patients were included in the study, the trend toward decreased risk remained for all-cause mortality as well as cardiovascular death, hospitalization, and repeat infarction.

The authors conclude that combined treatment with statins and beta blockers early after MI complicated by CHF improves outcomes. The effects of these drugs taken together appear to be additive.

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