Differential coronary heart disease risk among antihypertensive and lipid-lowering medication users versus non-users: A real-world data analysis

Abstract

BACKGROUND

We aimed to precisely quantify the risk of coronary heart disease (CHD) among antihypertensive medication users compared to non-users. We similarly assessed the potential CHD risk among lipid-lowering medication users.

METHODS

This retrospective cohort study used claims and health checkup data from 2014 to 2021 provided by DeSC Healthcare, Inc. We used percutaneous coronary intervention (PCI) risk as a proxy for the CHD outcome.

RESULTS

Among the 1,740,153 participants without a history of cardiovascular and kidney diseases, 3803 underwent PCI during a mean follow-up of 3.2 years. The Cox model with health insurers as the stratified factor showed that blood pressure (BP) classification according to the hypertension guidelines was linearly associated with PCI risk. In contrast, this association was weaker in antihypertensive medication users than in nonusers. After restricting to 1,309,460 participants with BP <140/<90 mm Hg, the antihypertensive medication users had a 1.51 (95% CI: 1.37-1.66) times higher PCI risk than nonusers even after adjusting for baseline characteristics including systolic BP. This was consistent in all subgroups stratified by characteristics including body mass index, drinking status, diabetes, systolic BP, and follow-up years. Meanwhile, the use of lipid-lowering medications was not associated with PCI risk (hazard ratio: 0.98, 95% CI: 0.88-1.09 in 1,221,390 patients with low-density lipoprotein cholesterol <3.62 mmol/L [<140 mg/dL]).

CONCLUSIONS

Especially for hypertension, it is important not only to lower BP with medication but also to avoid the need for medication through early prevention and lifestyle changes.