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Clin Pharmacol Ther. 2018 Jun;103(6):1038-1046. doi: 10.1002/cpt.864. Epub 2017 Sep 28.

Medications Recommended for Secondary Prevention After First Acute Coronary Syndrome: Effectiveness of Treatment Combinations in a Real-Life Setting.

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University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Bordeaux, France.
University Hospital of Bordeaux, Bordeaux, France.
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France.


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.

[Indexed for MEDLINE]

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