Effect of drug combinations on admission for recurrent myocardial infarction. Issue 10 (13th May 2007)

• Record Type: Journal Article
• Authors: van der Elst, Menno E; Bouvy, Marcel L; de Blaey, Cornelis J; de Boer, Anthonius
• Is Part Of: Heart. Volume 93:Issue 10(2007)
• Page Start: 1226
• Page End: 1230
• Publication Date: 2007-05-13
• Subjects: myocardial infarction -- secondary prevention -- combination drug therapy; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/hrt.2006.098053
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: To determine the effect of the number of different drugs with adherence to medication of at least 70% on recurrent admission for myocardial infarction (MI) in patients with a history of MI. Design: Nested case–control study in a dynamic cohort. Setting: PHARMO database that contains pharmacy dispensing records and hospital discharge records of 350 000 Dutch citizens. Subjects: All patients admitted to hospital for first MI (ICD-9 410) from 1991 to 2000 with at least a 30-day survival after admission. Cases were admitted for recurrent MI and were matched for age, sex, and year of admission with controls who did not have a recurrent MI. Main outcome measure(s): Odds ratio with 95% CI for admission for recurrent MI. Exposure was the number of preventive drugs (antiplatelet agents, statins and β blockers or ACE inhibitors) used for at least 70% of the time. Results: 389 cases were matched with 2344 controls. The use of one drug was associated with a 6% odds reduction (95% CI 30% reduction to 28% increase) for admission for recurrent MI. The use of two or three drugs was associated with reductions of 26% and 41% (47% reduction to 3% increase and 6% to 63% reduction, respectively). Addition of one drug caused a 16% reduction (4% to 26%). Conclusions: Multiple drug treatment decreases admissions for recurrent MI in patients with a history of MI. Every addition of a drug, regardless of drug class, reduces the risk even further. These results support the treatment strategies as applied in daily practice.