{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:05:16Z","timestamp":1791266716524,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,1,26]],"date-time":"2017-01-26T00:00:00Z","timestamp":1485388800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"French government","award":["ANR-10-IDEX-03-02"],"award-info":[{"award-number":["ANR-10-IDEX-03-02"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The secondary prevention treatment for acute coronary syndrome (ACS) is based on the combined use of drugs from four therapeutic classes (beta\u2010blockers, antiplatelet agents, statins, and angiotensin\u2010converting enzyme inhibitors or angiotensin receptor blockers). The objective of this study was to compare the long\u2010term effectiveness of the recommended therapeutic combination with those of incomplete combinations in secondary prevention of ACS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cohort study used data from a representative sample of the French national healthcare insurance system database. Patients hospitalised for an incident ACS between 2006 and 2011 and aged \u226520\u00a0years at the time of ACS were included in the study. Effectiveness in preventing the composite outcome ACS, transient ischemic attack, ischemic stroke or all\u2010cause\u2010death was estimated using time\u2010fixed and time\u2010dependent Cox proportional hazards models with different definitions of exposure (at inclusion or determined daily during follow\u2010up) and adjustment for patient characteristics, co\u2010morbidities and co\u2010medications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 2874 patients included in the study, 33.9% were women; median age was 67\u00a0years (interquartile range: 56\u201377). The median duration of follow\u2010up was 3.6\u00a0years (interquartile range: 2.2\u20135.3). Compared with the use of recommended combination, use of combination with three classes increased the risk of the composite outcome from 1.25 (95% confidence interval (95%CI), [1.07\u20131.47]) in the time\u2010fixed model and from 1.40 (95%CI, [1.15\u20131.70]) or 1.42 (95%CI, [1.13\u20131.79]) in the time\u2010dependent models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>After ACS, the use of incomplete drugs combinations compared with the recommended four drugs combination was associated with a higher risk of cardiovascular morbidity and all\u2010cause mortality. Copyright \u00a9 2017 John Wiley &amp; Sons, Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.4171","type":"journal-article","created":{"date-parts":[[2017,1,26]],"date-time":"2017-01-26T08:32:47Z","timestamp":1485419567000},"page":"285-293","source":"Crossref","is-referenced-by-count":19,"title":["Comparative effectiveness of recommended versus less intensive drug combinations in secondary prevention of acute coronary syndrome"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2568-1928","authenticated-orcid":false,"given":"Julien","family":"Bezin","sequence":"first","affiliation":[{"name":"University of Bordeaux, U1219  Bordeaux France"},{"name":"Department of Clinical Pharmacology University Hospital of Bordeaux  Bordeaux France"},{"name":"INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology Research Team  Bordeaux France"},{"name":"Bordeaux PharmacoEpi, INSERM CIC1401  Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf H.H.","family":"Groenwold","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Clinical Pharmacology Utrecht Institute for Pharmaceutical Sciences, Utrecht University  Utrecht The Netherlands"},{"name":"Julius Center for Health Sciences and Primary Care University Medical Center Utrecht  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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