title: Improved long-term survival in patients on combination therapies following an incident acute myocardial infarction: a longitudinal population-based study.
abstract: OBJECTIVE
  To investigate the single and combined effectiveness of commonly prescribed secondary preventive medications (post-acute myocardial infarction (AMI)) in reducing overall all-cause mortality and by gender.
  
  
  METHODS
  Population-based longitudinal cohort study.
  
  
  METHODS
  Western Australia, Australia.
  
  
  METHODS
  9580 individuals aged 65 years to 84 years who were admitted to hospital with their first AMI diagnosis between 1 January 1995 and 1 January 2006.
  
  
  METHODS
  Time to death from any cause out to 11 years after first AMI, identified from registry data, was the primary outcome measure. Cardiovascular drugs dispensed within 28 days following hospital discharge were identified as main exposure categories.
  
  
  RESULTS
  In total, 975 deaths occurred during 1 year follow-up, culminating to 3247 by 11 years. 1-year risk of death was significantly reduced for all drug combinations, but not for drugs dispensed in isolation. Out to 11 years, only combinations of 'β-blockers and statins' (with or without ACE inhibitors/angiotensin II receptor blockers (ACEi/ARB)) provided significant reductions in risk of all-cause mortality. In men, the greatest reduction in risk was associated with being dispensed 'β-blockers and statins' (HR 0.46, 95% CI 0.36 to 0.58), whereas women benefited most from being dispensed 'β-blockers, statins and ACEi/ARBs' (HR 0.77, 95% CI 0.60 to 0.99).
  
  
  CONCLUSIONS
  The combination of 'β-blockers and statins' (with or without ACEi/ARB) dispensed within 28 days postdischarge was associated with the greatest long-term survival following an AMI. Our observations of significantly reduced mortality risk in men (compared with women) who were dispensed 'β-blockers and statins', or 'β-blockers and ACEi/ARBs', warrants further investigation.
authors.affiliation: Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia. a.gunnell@ecu.edu.au
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Gunnell
authors.forename: Kristjana
authors.initials: K
authors.lastname: Einarsdóttir
authors.forename: Frank
authors.initials: F
authors.lastname: Sanfilippo
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
authors.forename: C D'Arcy J
authors.initials: CD
authors.lastname: Holman
authors.forename: Tom
authors.initials: T
authors.lastname: Briffa
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D057216:Propensity Score; D016016:Proportional Hazards Models; D014904:Western Australia / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Acute myocardial infarction; epidemiology; medications; mortality; sex