Background: Women's long-term patterns of evidence-based preventive medication use after a diagnosis of coronary heart disease have not been sufficiently studied. Methods: Postmenopausal women ages 50 to 79 years were eligible for randomization in the Women's Health Initiative's hormone trials if they met inclusion and exclusion criteria and were >80% adherent during a placebo-lead-in period and in the dietary modification trial if they were willing to follow a 20% fat diet. Those with adjudicated myocardial infarction or coronary revascularization after the baseline visit were included in the analysis (n = 2627). Baseline visits occurred between 1993 and 1998, then annually until the trials ended in 2002 through 2005; medication inventories were obtained at baseline and years 1, 3, 6, and 9. Results: Use at the first Women's Health Initiative visit after a coronary heart disease diagnosis increased over time for statins (49% to 72%; P < .0001), beta-blockers (49% to 62%; P = .003), and angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers (ACEI/ARBs; 26%-43%; P < .0001). Aspirin use remained stable at 76% (P = .09). Once women reported using a statin, aspirin, or beta-blocker, 84% to 89% reported use at 1 or more subsequent visits, with slightly lower rates for ACEI/ARBS (76%). Statin, aspirin, beta-blocker, or ACEI/ARB use was reported at 2 or more consecutive visits by 57%, 66%, 48%, and 28%, respectively. These drugs were initiated or resumed at a later visit by 24%, 17%, 15%, and 17%, respectively, and were never used during the period of follow-up by 19%, 10%, 33%, and 49% respectively. Conclusions: Efforts to improve secondary prevention medication use should target both drug initiation and restarting drugs in patients who have discontinued them.
- Coronary heart disease
- Secondary prevention
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Endocrinology, Diabetes and Metabolism
- Internal Medicine
- Nutrition and Dietetics