For patients with undiagnosed heart disease, taking a statin or beta blocker could mean the difference between experiencing mild chest pain, or having a full-blown heart attack as a first symptom. That’s the finding of a Kaiser Permanente study in the February 21 issue of the Annals of Internal Medicine.

Investigators with the Oakland-based Kaiser Permanente Division of Research, Stanford and UCSF Medical Center found that patients whose first warning sign of coronary disease was a heart attack were only half as likely to be taking a statin or beta blocker, compared with people whose first warning sign of coronary disease was exercise-induced angina.

“We know that statins and beta blockers can decrease your risk of heart disease,” said Alan Go, MD, a Kaiser Permanente researcher and the lead author of the study. “So if you are at increased risk for having heart disease and your doctor were to treat you with these types of medications, our study suggests that you are less likely to present with a heart attack, which has a very high risk of a bad outcome, and more likely to present with exercise-induced chest pain or chest pressure, a less deadly form of heart disease.”

Statins are among the most commonly prescribed medications in the United States. They are typically given to reduce cholesterol, one of the warning signs for heart disease. Beta blockers are typically prescribed to people with high blood pressure, another warning sign for heart disease.

“While doctors try to prevent coronary disease by treating high blood pressure and High cholesterol, it’s not 100 percent effective,” said Mark Hlatky, MD, professor of health research and policy and of medicine (cardiovascular medicine) at Stanford University School of Medicine, and a senior author of the study. “If there are warning symptoms like angina with exercise, there is enough time to see a doctor and get started on effective treatments that reduce risk. Having a heart attack causes permanent damage, even if it doesn’t kill you.”

The study evaluated nearly 1,400 adult male and female Kaiser Permanente patients in Northern California and found that only 20 percent of those who had suffered a heart attack were on a statin, compared with 40 percent of patients who presented with exertional angina. The researchers also found that women were less likely than men to have a heart attack as the first symptom of heart disease.

“I think our study lends additional support to the evidence already out there that statins and beta blockers are effective in heart disease prevention,” said Go, of Kaiser Permanente. “Furthermore, it suggests you can decrease the chance of your heart disease being a more severe form if you are taking these medications.”

http://www.kaiserpermanente.org/