背景:药物治疗,包括抗心绞痛治疗,是稳定缺血性心脏病(SIHD)管理的基石。然而,目前尚不清楚联合抗心绞痛药物是否在生活质量(QoL)和心血管结局方面提供了超越单药治疗的益处。方法:我们利用了BARI-2D试验的数据,比较了SIHD和糖尿病患者的心血管和QoL结局,这些患者随机分为强化药物治疗或单纯强化药物治疗的血运重建。我们将患者分为三组:≥2vs.1vs.0抗心绞痛。我们比较了患者特征,QoL指标,基线和5年时的心血管终点,创建多变量模型来调整关键临床混杂因素结果:在2,368例患者中,348例(14.7%)患者使用0种抗心绞痛药物,1,020例患者(43.1%)使用1抗心绞痛,1,000名患者(42.2%)在基线时使用≥2种抗心绞痛药物。最常见的抗心绞痛类是β受体阻滞剂。在基线,0抗心绞痛患者的QoL指标更好(自我健康评分,杜克活动状态指数,和能量等级)高于≥2种抗心绞痛药的患者。然而,在1年的随访中,仅服用1次抗心绞痛的患者比服用0次抗心绞痛的患者表现出更大的QoL改善,在服用≥2种抗心绞痛药的患者中,QoL指标没有任何增量益处,即使在调整了多个协变量如年龄之后,心力衰竭,糖尿病控制,和心肌危险指数.最后,在5年的随访中,调整后,全因死亡率没有差异,主要不良心血管事件,在服用不同数量的抗心绞痛药的患者之间或心肌梗死。结论:在一年的随访中,与使用两种或更多种抗心绞痛药相比,使用单一抗心绞痛药治疗SIHD和糖尿病的成年人的QoL改善相似或更好。这些发现值得进一步研究,以更好地了解药物治疗强度对SIHD和相关合并症患者QoL的影响。
Medical therapy, including antianginal treatment, is the cornerstone in the management of stable ischemic heart disease (SIHD). However, it remains unclear whether combining antianginal agents provides benefits beyond monotherapy in terms of quality of life (QoL) and cardiovascular outcomes. We used data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial, which compared cardiovascular and QoL outcomes in patients with SIHD and diabetes mellitus randomized to revascularization with intensive medical therapy or intensive medical therapy alone. We categorized patients into 3 groups: ≥2 versus 1 versus 0 antianginals. We compared patient characteristics, QoL metrics, and cardiovascular end points at baseline and at 5 years, creating a multivariable model to adjust for key clinical confounders. Of 2,368 patients, 348 patients (14.7%) were on 0 antianginals, 1,020 patients (43.1%) were on 1 antianginal, and 1,000 patients (42.2%) were on ≥2 antianginals at baseline. The most common antianginal class was β blockers. At baseline, patients on 0 antianginals had better QoL metrics (self-health score, Duke activity status index, and energy rating) than patients on ≥2 antianginals. However, at the 1-year follow-up, patients taking only 1 antianginal showed greater QoL improvement than those taking 0 antianginal, without any incremental benefit in QoL metrics seen in patients taking ≥2 antianginal agents, even after adjusting for multiple covariates such as age, heart failure, diabetes control, and myocardial jeopardy index. Lastly, at the 5-year follow-up, after adjustment, there were no differences in all-cause mortality, major adverse cardiovascular events, or myocardial infarction between patients taking different numbers of antianginals. Adults on a single antianginal for SIHD and diabetes mellitus had similar or better improvements in QoL than those on 2 or more antianginal agents at 1 year of follow-up. These findings merit further research to better understand the impact of medical therapy intensity on QoL in patients with SIHD and associated co-morbidities.