Cardioprotective medication use and risk factor control among US adults with unrecognized myocardial infarction: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study

Figures & data

Table 1 Baseline characteristics by myocardial infarction status

	No MI (n = 18,513)	UMI (n = 949)	RMI (n = 1574)
Age, years	63.5 (9.6)	67.0 (9.8)	68.1 (9.3)
Female, %	64.5	58.5	44.1
Black, %	41.3	42.5	37.9
Diabetes, %	22.6	28.7	37.8
Estimated glomerular filtration rate, %
≥60 mL/minute/1.73 m^2	90.8	84.4	78.7
45–59 mL/minute/1.73 m^2	6.1	9.0	12.3
<45 mL/minute/1.73 m^2	3.1	6.7	9.0
Cigarette smoking, %
Current	14.2	18.1	18.6
Past	36.8	36.9	47.3
Never	49.1	45.0	34.1
Health insurance, %	92.5	93.7	95.2
Regular source of health care, %	82.9	84.4	83.2
Income, %
<$20,000	16.2	23.4	25.6
$20,000–$34,999	23.0	22.8	26.9
$35,000–$74,999	30.4	25.7	25.1
≥$75,000	17.4	14.1	10.1
Refused	13.0	14.0	12.3
Education, %
Less than high school	10.6	14.2	18.9
High school	25.7	28.9	29.1
Some college	27.9	22.9	25.3
College graduate	35.8	34.0	26.7
Region, %
South	68.9	69.3	69.1
Northeast	6.0	6.1	6.6
Midwest	12.9	14.5	14.5
West	12.2	10.0	9.8

Note: Numbers represent mean (standard deviation) or percent.

Abbreviations: MI, myocardial infarction; RMI, recognized myocardial infarction; UMI, unrecognized myocardial infarction.

Figure 1 Medication use by myocardial infarction status.

Abbreviations: ACEI/ARB, angiotensin converting enzyme inhibitor or angiotensin receptor blocker; MI, myocardial infarction; RMI, recognized myocardial infarction; UMI, unrecognized myocardial infarction.

Table 2 Prevalence of medication use by myocardial infarction status

	No MI (n = 18,513)	UMI (n = 949)	RMI (n = 1574)
Proportions (%)
Aspirin	38.4	44.4	75.7
Beta blockers	18.0	25.8	57.2
ACEI/ARBs	31.7	38.7	55.0
Statins	28.1	33.9	64.1
One or more medications	64.5	74.2	95.2
Two or more medications	35.1	44.9	79.0
Three or more medications	13.6	19.0	55.4
Four medications	3.0	4.7	22.5
Prevalence ratios (95% CI)*
Aspirin	1 (reference)	1.06 (0.99–1.14)	1.72 (1.66–1.78)
Beta blockers	1 (reference)	1.32 (1.18–1.47)	2.85 (2.70–3.02)
ACEI/ARBs	1 (reference)	1.13 (1.04–1.22)	1.59 (1.51–1.67)
Statins	1 (reference)	1.11 (1.02–1.22)	2.01 (1.92–2.11)
One or more medications	1 (reference)	1.08 (1.04–1.12)	1.36 (1.34–1.38)
Two or more medications	1 (reference)	1.16 (1.08–1.25)	1.97 (1.90–2.03)
Three or more medications	1 (reference)	1.24 (1.08–1.42)	3.41 (3.20–3.62)
Four medications	1 (reference)	1.40 (1.04–1.88)	6.08 (5.32–6.95)

Note: *Prevalence ratios are adjusted for age, sex, and race.

Abbreviations: ACEI/ARB, angiotensin converting enzyme inhibitors or angiotensin receptor blocker; CI, confidence interval; MI, myocardial infarction; RMI, recognized myocardial infarction; UMI, unrecognized myocardial infarction.

Table 3 Prevalence of medication use by cardiovascular disease status

	No CVD* (n = 16,757)	UMI (n = 792)	Recognized CVD (n = 3487)
Proportions (%)
Aspirin	35.8	38.8	69.3
Beta blockers	16.0	22.7	46.7
ACEI/ARBs	29.8	35.1	52.7
Statins	25.7	29.4	57.2
One or more medications	61.9	70.3	92.0
Two or more medications	31.8	39.0	72.7
Three or more medications	11.3	14.0	45.2
Four medications	2.2	2.7	16.0
Prevalence ratios (95% CI)**
Aspirin	1 (reference)	1.01 (0.93–1.10)	1.73 (1.67–1.78)
Beta blockers	1 (reference)	1.32 (1.16–1.51)	2.66 (2.53–2.80)
ACEI/ARBs	1 (reference)	1.10 (0.99–1.21)	1.62 (1.56–1.69)
Statins	1 (reference)	1.07 (0.96–1.19)	2.01 (1.93–2.09)
One or more medications	1 (reference)	1.07 (1.02–1.12)	1.38 (1.35–1.40)
Two or more medications	1 (reference)	1.13 (1.03–1.23)	2.04 (1.97–2.10)
Three or more medications	1 (reference)	1.13 (0.95–1.35)	3.46 (3.27–3.68)
Four medications	1 (reference)	1.08 (0.70–1.67)	6.04 (5.27–6.91)

Notes: *CVD includes myocardial infarction, stroke, abdominal aortic aneurysm, coronary artery revascularization, carotid artery revascularization, or peripheral artery revascularization ACEI/ARBs;

** adjusted for age, sex, and race.

Abbreviations: ACEI/ARB, angiotensin converting enzyme inhibitors or angiotensin receptor blocker; CI, confidence interval; CVD, cardiovascular disease; UMI, unrecognized myocardial infarction.

Table 4 Blood pressure and low-density lipoprotein cholesterol control by myocardial infarction status

	UMI (n = 949)	RMI (n = 1574)	P
Proportions (%)
Blood pressure < 140/90 mmHg	71.9	73.9	0.27
LDL cholesterol < 100 mg/dL	38.8	55.4	<0.001
LDL cholesterol < 70 mg/dL	10.5	17.7	<0.001
Prevalence ratios*
Blood pressure < 140/90 mmHg	1 (reference)	1.03 (0.93–1.13)	0.58
LDL cholesterol < 100 mg/dL	1 (reference)	1.35 (1.19–1.52)	,0.001
LDL cholesterol < 70 mg/dL	1 (reference)	1.56 (1.24–1.96)	,0.001

Note: *Prevalence ratios are adjusted for age, sex, and race.

Abbreviations: LDL, low-density lipoprotein; RMI, recognized myocardial infarction; UMI, unrecognized myocardial infarction.

Figure 2 Predictors of medication use among 949 participants with unrecognized myocardial infarction.

Note: Prevalence ratios (circles) and 95% confidence intervals (lines) are adjusted for age, race, and sex