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Atherosclerosis. 2014 Aug;235(2):496-502. doi: 10.1016/j.atherosclerosis.2014.05.918. Epub 2014 Jun 5.

Anti-anxiety drugs use and cardiovascular outcomes in patients with myocardial infarction: a national wide assessment.

Author information

1
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
2
Health Management Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Family Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
3
Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, Taiwan.
4
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
5
Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.
6
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan. Electronic address: hspenos@yahoo.com.tw.

Abstract

OBJECTIVE:

Anti-anxiety medication in patients with anxiety may lessen the stress and thereby lower their risk for myocardial infarction (MI). The aim of current study is to examine an association between the use of anti-anxiety medication and long-term mortality risk in patients following MI.

METHODS:

A universal national health insurance (NHI) program has been implemented in Taiwan since 1995. We used system sampling database from 1997 to 2008 with a total of 1,000,000 subjects. We included subjects with first episode of MI and were above 30 years old. Sudden death, cardiovascular mortality, and heart failure hospitalization were assessed in all included subjects. Anti-anxiety as well as other medications and risk factors were obtained. Cox regression analysis was used to evaluate the adjusted hazard ratio (HR) for all patients and subgroups.

RESULTS:

The adjusted HRs of sudden death were significantly associated with increased benzodiazepam (BZD) dosage (HRs = 0.639, 1.003, 1.957 from Q2 to Q4 vs. Q1, p = .019 for trend) during approximately 4.8 years. For cardiac mortality and heart failure hospitalization, there was a J-curve dose-response relationship. The HRs for cardiac mortality were 0.255 (p < .001) and 0.385 (p < .001) for Q2 and Q3 vs. Q1, respectively. For patients receiving higher doses of daily BZDs (>5 mg), protective effects for cardiac mortality and heart failure hospitalization decreased and a J-curve dose-response relationship was seen.

CONCLUSION:

Anti-anxiety medications are independent associated with a decreased risk of cardiac mortality and heart failure hospitalization in patients after a new MI.

KEYWORDS:

Anti-anxiety; Cardiovascular; Myocardial infarction; Outcome

[Indexed for MEDLINE]

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