Key result
Omitting statins from post-MI therapy in dementia is linked to ~15% fewer recurrent MIs.
Why the study?
Statins, RASIs, and beta-blockers are guideline-recommended post-MI for secondary prevention, but evidence for people with dementia is scarce.
Does the use of single or dual guideline-recommended cardiovascular medications (statins, RASIs, beta-blockers) compared to triple therapy reduce recurrent MI, MACE, and all-cause mortality in people with dementia post-myocardial infarction?
Cohort (n=288,482)
Yes
Does the use of single or dual guideline-recommended cardiovascular medications (statins, RASIs, beta-blockers) compared to triple therapy reduce recurrent MI, MACE, and all-cause mortality in people with dementia post-myocardial infarction?
In patients with dementia post-myocardial infarction, dual therapy with statins and RASIs provides similar survival benefits to triple therapy, suggesting that beta-blockers may not offer additional survival benefit in this specific population.
BACKGROUND: Statins, renin-angiotensin system inhibitors (RASIs) and beta-blockers are guideline-recommended cardiovascular medications post-myocardial infarction (MI) for secondary prevention, but evidence for people with dementia is scarce. OBJECTIVE: To evaluate the association between post-MI cardiovascular medication use and the risk of cardiovascular outcomes and mortality, focusing on people with dementia. DESIGN: Large retrospective cohort study using data from Australia, Finland, Taiwan, the UK and the USA. SUBJECTS: People with and without dementia. METHODS: Seven exposure groups were assigned using one or combinations of the three guideline-recommended medication classes-(i) statin, RASI and beta-blocker, (ii) statin and beta-blocker, (iii) statin and RASI, (iv) RASI and beta-blocker, (v) statin only, (vi) beta-blocker only and (vii) RASI only, based on medication records during a 60-day landmark period post-MI. Recurrent MI, major adverse cardiovascular event (MACE) and all-cause mortality were evaluated as outcomes. Jurisdiction-specific results were pooled together using meta-analyses. RESULTS: A total of 28 122 people with dementia and 260 360 people without dementia were included. Among people with dementia, using any single or two medications carried a similar risk of recurrent MI and MACE as using all three guideline-recommended medications, except that using RASI and a beta-blocker without a statin was associated with a lower risk of recurrent MI (HR 0.85; 95% CI, 0.75-0.96). Using a statin and RASI without beta-blockers resulted in similar all-cause mortality to using all three (HR 1.16; 95% CI, 0.97-1.39), while all the remaining single- or dual-medication regimens were associated with higher risks of all-cause mortality. CONCLUSIONS: For people with dementia, using one or two guideline-recommended medications appeared sufficient to protect against recurrent MI and MACE. Beta-blockers may not provide additional survival benefits over statins and RASIs.
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Ilomäki et al. (2026) conducted a cohort in Myocardial infarction in people with dementia (n=288,482). One or two guideline-recommended cardiovascular medications (statin, RASI, beta-blocker) vs. Triple combination of statin, RASI, and beta-blocker was evaluated on Recurrent MI (RASI and beta-blocker without statin vs all three in dementia) (HR 0.85, 95% CI 0.75-0.96). In people with dementia, using a RASI and a beta-blocker without a statin was associated with a lower risk of recurrent MI compared to using all three medications (HR 0.85).
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