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Medications Recommended for Secondary Prevention After First Acute Coronary Syndrome: Effectiveness of Treatment Combinations in a Real‐Life Setting
Author(s) -
Bezin Julien,
Klungel Olaf H.,
Lassalle Régis,
DureauPournin Caroline,
Moore Nicholas,
Pariente Antoine
Publication year - 2018
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt.864
Subject(s) - medicine , acute coronary syndrome , angiotensin receptor blockers , confidence interval , secondary prevention , pharmacoepidemiology , angiotensin converting enzyme , intensive care medicine , pharmacology , myocardial infarction , blood pressure , medical prescription
Long‐term effectiveness of evidence‐based cardiovascular medications (EBCMs) indicated after acute coronary syndrome (ACS) needs to be assessed considering the combination effects for these drugs recommended in association. Using a nationwide database, we conducted a cohort study to evaluate the effectiveness of all possible incomplete EBCMs‐based combinations as compared to that associating the four recommended EBCMs over up to 5 years of follow‐up. Among the 31,668 patients included, 22.9% had ACS recurrence or died during follow‐up. The risks associated with the use of 3‐EBCM based combinations were 1.46 (95% confidence interval: 1.33–1.60) for the combinations without statins, 1.30 (1.17–1.43) for the combinations without angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers, 1.11 (0.98–1.25) for the combinations without antiplatelet agents, and 0.99 (0.89–1.10) for the combination without beta‐blockers. These findings question the interest of maintaining long‐term treatment with beta‐blockers in addition to the other EBCMs for post‐ACS secondary prevention.