Effectiveness of recommended drug classes in secondary prevention of acute coronary syndrome in France

Julien Bezin, Rolf Groenwold, Sanni Ali, Régis Lassalle, Anthonius De Boer, Nicholas Moore, Olaf Klungel, Antoine Pariente

Research output: Contribution to journalMeeting AbstractOther research output


Background: Guidelines for cardiovascular secondary prevention are based on evidence from relatively old clinical trials and need to be evaluated in daily clinical practice. Objectives: To evaluate effectiveness of the recommended drug classes after an acute coronary syndrome (ACS) for secondary prevention of cardiovascular diseases and all-cause mortality. Methods: This cohort study used data from a representative sample of the French national healthcare insurance system database (EGB). Patients hospitalised for an incident ACS between 2006 and 2011, and aged ≥ 20 years at time of ACS were included in the study. Patients non-exposed to any of the four recommended drug classes (beta-blockers, antiplatelet agents, statins, and angiotensin-converting-enzyme inhibitors, ACEI, or angiotensin II receptor blockers, ARB) in the first 3 months following ACS or who died during this period were not included in the cohort. Exposure status was determined daily during follow-up. Effectiveness of the four therapeutic classes in preventing the composite outcome ACS, transient ischemic attack, ischemic stroke, or all-cause-death was estimated using a time-dependent Cox proportional hazards model, which was adjusted for time-fixed confounders measured at baseline (general characteristics and characteristics of the initial ACS) and time-dependent confounders during follow-up (co-morbidities and co-medications). Results: Of the 2874 patients included in the study, 33.9% were women and the median age was 67 years (interquartile range, IQR: 56-77). The median time of follow-up was 3.6 years (IQR: 2.2-5.3). The risk of the composite outcome decreased with use of antiplatelet agents (adjusted hazard ratio (aHR) 0.76, 95% confidence interval (CI) 0.63; 0.91), use of statins (aHR 0.71, 95%CI 0.57; 0.87), and use of ACEI/ARB (aHR 0.67, 95%CI 0.57; 0.80). Use of beta-blockers was not associated with a lower risk of the composite outcome (aHR, 0.90, 95%CI 0.74; 1.09]). Conclusions: Use of antiplatelet agents, statins, and ACEI/ARB after an ACS, but not beta-blockers, was associated with a lower risk of cardiovascular morbidity and all-cause mortality.
Original languageEnglish
Pages (from-to)258-259
Number of pages2
JournalPharmacoepidemiology and Drug Safety
Issue numberS3
Publication statusPublished - Aug 2016
Event32nd International conference on Pharmacoepidemiology & Therapeutic Risk Management - The convention centre Dublin, Dublin, Ireland
Duration: 25 Aug 201628 Aug 2016


  • angiotensin receptor antagonist
  • antithrombocytic agent
  • beta adrenergic receptor blocking agent
  • dipeptidyl carboxypeptidase inhibitor
  • endogenous compound
  • hydroxymethylglutaryl coenzyme A reductase inhibitor
  • acute coronary syndrome
  • adult
  • aged
  • cardiovascular system
  • cause of death
  • clinical trial
  • cohort analysis
  • comorbidity
  • confidence interval
  • controlled study
  • data base
  • exposure
  • female
  • follow up
  • France
  • hazard ratio
  • human
  • insurance
  • major clinical study
  • male
  • morbidity
  • prevention
  • proportional hazards model
  • secondary prevention
  • transient ischemic attack
  • young adult


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