Number of drugs used in secondary cardiovascular prevention and late survival in the population of Valencia Community, Spain

Drug treatment for secondary prevention of cardiovascular disease is recommended by guidelines, but it is not always followed in real life. This study wanted to assess the size of this gap and its impact on mortality in subjects after a cardiovascular event (MACE). Patients with any of MACE in the period from January 1st 2011 to December 31st 2013, and more than one year of follow-up were selected from population of the Valencian Community. Drugs for secondary prevention were antiplatelets, renin-angiotensin system blockers and statins. Assessment of treatment was performed one year after the initial event. Mortality risk was assessed using Cox by the number of drug classes (G0 no medication, G1 one, G2 two and G3 three drugs) adjusted by confounders. A total of 92,436 patients (62% men, mean age 72 years) of whom 60.5% presented with stroke, 30.6% with myocardial infarction and 8.9% with revascularization were included. Among them, 4.1% were G0, 20.2% G1, 32.9% G2 and 42.7% G3. A progressive decrease in mortality was observed in G1 (HR 0.83, CI 95% 0.73–0.95), G2 (HR 0.70, CI 95% 0.60–0.82) and G3 (HR 0.61, CI95% 0.51–0.74) vs. G0. In diabetic subgroup, significant reduction of risk was observed in the G2 (0.79, CI 95% 0.63–0.98) and G3 (0.72, CI9 5% 0.56–0.95), but not in G1 (0.97, CI 95% 0.80–1.17). A gap between guidelines and reality in the use of cardiovascular protecting drugs one year after the initial event still exists and it is largely related with all-cause late mortality. •Real world data will monitor compliance for secondary prevention of cardiovascular disease.•Less than half of the examined subjects were on an adequately three-drug prevention schedule.•The survival hazard ratios were progressively better as more drug classes were used for prevention.•Efforts should be done for improving compliance in secondary prevention.