Combination therapy with β-blockers and statins reduced 11-year all-cause mortality in men (HR 0.46; 95% CI 0.36-0.58), while women benefited most from adding ACEi/ARBs (HR 0.77; 95% CI 0.60-0.99).
Cohort (n=9,580)
Do combinations of secondary preventive medications reduce all-cause mortality in older adults following a first acute myocardial infarction?
Combination therapy with beta-blockers and statins (with or without ACEi/ARB) early after a first AMI is associated with significant long-term survival benefits in older adults, with potential sex differences in optimal regimens.
Hazard Ratio: 0.46 (95% CI 0.36–0.58)
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. DESIGN: Population-based longitudinal cohort study. SETTING: Western Australia, Australia. PARTICIPANTS: 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. MAIN OUTCOME MEASURES: 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.
Gunnell et al. (Thu,) conducted a cohort in acute myocardial infarction (n=9,580). Combination therapies (β-blockers and statins, with or without ACEi/ARBs) vs. Drugs dispensed in isolation or other combinations was evaluated on Time to death from any cause out to 11 years after first AMI (HR 0.46, 95% CI 0.36-0.58). Combination therapy with β-blockers and statins reduced 11-year all-cause mortality in men (HR 0.46; 95% CI 0.36-0.58), while women benefited most from adding ACEi/ARBs (HR 0.77; 95% CI 0.60-0.99).