Effect of drug combinations on admission for recurrent myocardial infarction

Heart. 2007 Oct;93(10):1226-30. doi: 10.1136/hrt.2006.098053. Epub 2007 May 13.


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 beta 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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Aged
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Case-Control Studies
  • Drug Combinations
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Male
  • Myocardial Infarction / drug therapy*
  • Myocardial Infarction / epidemiology
  • Netherlands / epidemiology
  • Odds Ratio
  • Platelet Aggregation Inhibitors / therapeutic use
  • Recurrence
  • Regression Analysis


  • Adrenergic beta-Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Drug Combinations
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Platelet Aggregation Inhibitors