Effects of Medication on Cardiovascular Events in the Japanese Coronary Artery Disease (JCAD) Study

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概要

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• Background Actual data regarding coronary artery disease (CAD) patients in Japan is scarce, so in the present study a large database of Japanese patients with significant CAD was constructed for analysis of the relationship between medical treatments and outcomes in this cohort. Methods and Results The present study enrolled 15, 628 patients who underwent coronary angiography and were diagnosed as having significant stenosis in at least 1 coronary artery. Of these, 13, 812 patients were followed up and included in the analysis : 10, 626 (77%) men and 3, 186 (23%) women. Diagnosis at the time of registration was acute myocardial infarction (AMI) for 2, 955 patients, old myocardial infarction for 3, 913 patients and unstable angina pectoris for 2, 049 patients. Patients were followed up for an average of 2.7 years. At the start of the follow-up, 37.4% of the patients were prescribed statins, 50.2% calcium-channel blockers (CCB), 31.6% angiotensin-converting enzyme inhibitors (ACEI), 13.5% angiotensin II receptor blockers (ARB) and 60.2% nitrates. Univariate Cox regression model analysis showed that the hazard ratio (HR) of statins was 0.780 (95% confidence intervals (CI), 0.710-0.856 ; p<0.001) ; fibrates, 0.580 (95%CI, 0.425-0.790 ; p=0.001) ; CCB, 1.067 (95%CI, 0.976-1.166 ; p=0.153) ; ACEI, 1.062 (95%CI, 0.968-1.166; p=0.202) ; ARB, 1.036 (95%CI, 0.914-1.174 ; p=0.581); nitrates, 1.147 (95%CI, 1.043-1.260 ; p=0.005). When the data were adjusted for background data and all cardiovascular medications, the HR of statins was 0.809 (95%CI, 0.726-0.901 ; p<0.001), CCB 1.031 (95%CI, 0.937-1.135 ; p=0.535), ACEI 1.023 (95%CI, 0.924-1.132; p=0.663), ARB 0.991 (95%CI, 0.867-1.132; p=0.890), nitrates 1.074 (95%CI, 0.973-1.186 ; p=0.155). For patients presenting with AMI at the time of registration, the HR of CCB was 1.340 (95%CI, 1.084-1.655 ; p=0.007) and that of nitrates was 0.862 (95%CI, 0.703-1.059 ; p=0.157). Conclusion In a cohort of CAD patients in Japan, the prescription pattern differed from that of Western studies. Statins and fibrates were shown to be significantly beneficial in the whole cohort. In the AMI subgroup, CCB showed a deleterious effect and nitrates showed a non-significant tendency for beneficial effect, which should be investigated in future randomized control trials.

• 2007-11-20

著者

• Yamazaki Tsutoinu

  Department Of Clinical Epidemiology And Systems University Of Tokyo

• Yamazaki Tsutomu

  Clinical Epidemiology & Systems, University of Tokyo

• Kohro Takahide

  Department of Translational Research for Healthcare and Clinical Science, The University of Tokyo

• Hayashi Dobun

  Department of Cardiovascular Medicine, The University of Tokyo

• Kadowaki T

  Department Of Translational Research For Healthcare And Clinical Science University Of Tokyo

• Kohro Takahide

  Department Of Cardiology Tokyo University School Of Medicine

• Hayashi Doubun

  Department Of Translational Research For Health Care And Clinical Science Graduate School Of Medicin

• Hayashi Dobun

  Department Of Cardiovascular Medicine University Of Tokyo Graduate School Of Medicine

• OKADA Yoshihiro

  Department of Translational Research for Healthcare and Clinical Science

• Nagai Ryozo

  Cardiovascular Medicine, The University of Tokyo

• Hayashi Dobun

  Department Of Cardiovascular Medicine The University Of Tokyo

• Kadowaki Takashi

  Department Of Translational Research For Healthcare And Clinical Science University Of Tokyo

• Kadowaki Takashi

  東京大学 医学系研究科代謝栄養病態学

• Kadowaki Takashi

  Department Of Cardiovascular Medicine Graduate School Of Medicine University Of Tokyo

• Kohro Takahide

  Department Of Translational Research For Healthcare And Clinical Science University Of Tokyo

• Kohro Takahide

  Department Of Translational Research For Healthcare And Clinical Science

• Kohro Takahide

  Department Of Translational Research For Health Care And Clinical Science Graduate School Of Medicin

• Nagai Ryouzou

  The Department Of Cardiovascular Diseases Graduate School Of Medicine University Of Tokyo

• Kadowaki Takashi

  Department Of Human Genetics Graduate School Of Medicine University Of Tokyo

• Yamazaki Tsutomu

  Department Of Clinical Epidemiology & Systems Graduate School Of Medicine The University Of Toky

• Yamazaki Tsutomu

  Department Of Clinical Epidemiology & Systems The University Of Tokyo

• Okada Yoshihiro

  Department Of Electronics Himeji Institute Of Technology

• Yamazaki Tsutomu

  Department Of Clinical Epidemiology And Systems University Of Tokyo Graduate School Of Medicine

• Hayashi Dobun

  Healthcare Center Nippon Yusen Kaisya

• Yamazaki Tsutomu

  Clinical Bioinformatics, University of Tokyo Graduate School of Medicine

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