TY - JOUR
T1 - Medications Recommended for Secondary Prevention After First Acute Coronary Syndrome
T2 - Effectiveness of Treatment Combinations in a Real-Life Setting
AU - Bezin, Julien
AU - Klungel, Olaf H
AU - Lassalle, Régis
AU - Dureau-Pournin, Caroline
AU - Moore, Nicholas M
AU - Pariente, Antoine
N1 - © 2017 American Society for Clinical Pharmacology and Therapeutics.
PY - 2018/6
Y1 - 2018/6
N2 - 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.
AB - 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.
U2 - 10.1002/cpt.864
DO - 10.1002/cpt.864
M3 - Article
C2 - 28875506
SN - 0009-9236
VL - 103
SP - 1038
EP - 1046
JO - Clinical Pharmacology and Therapeutics
JF - Clinical Pharmacology and Therapeutics
IS - 6
ER -