Received April 28, 2008
Accepted on May 16, 2008

ORIGINAL ARTICLES

Associations of Kidney Function with Cardiovascular Medication Use after Myocardial Infarction

Division of Pharmacoepidemiology and Pharmacoeconomics and Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts

¹ To whom correspondence should be addressed. E-mail: wwinkelmayer{at}partners.org.

	Abstract

Background and objectives: It is unknown whether adherence to recommended medications after myocardial infarction (MI) differs by kidney function.

Design, setting, participants, & measurements: This was a retrospective cohort study of older patients who were discharged after MI in two Eastern states between 1995 and 2004. Patients were categorized as having ESRD, having chronic kidney disease (CKD), and being free from diagnosed CKD. Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB), blockers (BB), and statins was assessed within 30 d after discharge. Good adherence was defined as proportion of days covered >80% during the first year after discharge.

Results: Compared with patients with no CKD, patients with CKD had 22% lower adjusted use of ACEI/ARB but similar rates of BB and statin use. Patients with ESRD experienced 43% lower ACEI/ARB and 17% lower statin use. Only 64% (BB), 57% (statins), and 54% (ACEI/ARB) of patients had good 1-yr adherence. Adherence was similar between patients with CKD and with no CKD for all study drugs. Fewer patients with ESRD had good adherence to BB.

Conclusions: With the exception of lower ACEI/ARB use in patients with CKD, we found no differences between patients with CKD and with no CKD in their use of and adherence to these cardiovascular medications after MI. Patients with ESRD experienced lower use of ACEI/ARB and statins and lower adherence to BB regimens. Postulated differences in medication use after MI across levels of kidney function are unlikely to explain the observed differences in long-term outcomes.