PT - JOURNAL ARTICLE AU - Menno E van der Elst AU - Marcel L Bouvy AU - Cornelis J de Blaey AU - Anthonius de Boer TI - Effect of drug combinations on admission for recurrent myocardial infarction AID - 10.1136/hrt.2006.098053 DP - 2007 Oct 01 TA - Heart PG - 1226--1230 VI - 93 IP - 10 4099 - http://heart.bmj.com/content/93/10/1226.short 4100 - http://heart.bmj.com/content/93/10/1226.full SO - Heart2007 Oct 01; 93 AB - 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.