Prescribing pattern of angiotensin- converting enzyme inhibitors and beta blockers after acute myocardial infarction.

n recent years, many clinical trials suggested using certain medications such as beta-blockers (BB), angiotensin converting enzyme inhibitors (ACE-I), low dose aspirin, and statins to reduce morbidity and mortality after acute myocardial infarction (AMI). Since the 1980s, we have known the clinical benefits of BB post AMI. Angiotensin converting enzyme inhibitors are also useful in managing asymptomatic and symptomatic leftventricular dysfunction (LVD), and thus preventing the development of cardiac remodeling process after AMI.1 Lipid lowering agents, in particular statins decrease the risk of coronary events and total mortality in patients after myocardial infarction.2 Previous randomized trials illustrate the significant reductions of mortality rate in patients receiving aspirin for secondary prevention after AMI.3 To evaluate the impact of these clinical trials and evidence based medicine on physician practice pattern, we examined the trends in the use of BB, ACE-I and other medication therapy in patients discharged after AMI. We tried to identify clinical factors associated with ACE-I prescribing patterns. The data were collected from Al-Watani Governmental Hospital in Nablus, Palestine from January to December 2004. The medical files of patients admitted to the ICU and diagnosed with AMI were reviewed and analyzed. An ECG, enzymes, and symptoms confirmed the diagnosis of AMI. Data obtained from medical files included age, gender, medical history, blood pressure, heart rate, myocardial infarction (MI) type and left ventricular ejection fraction (LVEF). The use of medications at admission and discharge was also reports in adults of 42.9%,1 however, there is no record of striae distensae among obese children. Previous reports demonstrate intertrigo among obese individuals,4 and we similarly observed this in the present work, as we found intertrigo higher in obese versus normal adult individuals and children. Dry skin was a common problem found more in the obese individuals, mainly affecting cheeks, dorsa of the hands, feet, and legs. This observation was not noticed before, and we could find no clear explanation. We found hyperhidrosis high in obese individuals, when compared to overweight and normal weight children, and similarly found in adult obese in comparison with normal weight individuals. Previous reports confirm this.5 Previous studies found skin infections, mainly in the form of boils, wart, tinea cruris, and erythrasma increased among obese individuals.1 While in the present work although they did not reach statistically significant levels, we found more in obese individuals than normal weight individuals, apart from erythrasma, which was significantly high in adult obese individuals. The association between hirsutism and obesity was not be clear the in literature, and often hirsutism had been reported to be high in obese females with PCOS.3 Similarly, in the present work, although it did not reach a statistically significant level, we found more in adult obese females than normal weight females. The excessive fat deposition that leads to thickening of the fatty layer all over the body deserves the term adipomegaly, rather than obesity as it is more scientific, academic, and more socially and publically accepted. In conclusion, skin manifestations are a common problem, and important markers of obesity reflecting impaired metabolism, especially acanthosis nigricans, skin tags, and planter hyperkeratosis.