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Initiation and adherence to secondary prevention pharmacotherapy after myocardial infarction in patients with rheumatoid arthritis: a nationwide cohort study
  1. Jesper Lindhardsen1,
  2. Ole Ahlehoff1,
  3. Gunnar Hilmar Gislason1,
  4. Ole Rintek Madsen2,
  5. Jonas Bjerring Olesen1,
  6. Christian Torp-Pedersen1,
  7. Peter Riis Hansen1
  1. 1Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
  2. 2Department of Internal Medicine – Rheumatology section, Gentofte University Hospital, Copenhagen, Denmark
  1. Correspondence to Jesper Lindhardsen, Copenhagen University Hospital Gentofte, Department of Cardiology, Hellerup 2900, Denmark; jeslin01{at}


Objectives To examine whether rheumatoid arthritis (RA) is associated with less optimal secondary prevention pharmacotherapy after first-time myocardial infarction (MI).

Methods The authors identified all patients with first-time MI in the Danish National Patient Register from 2002 to 2009 and gathered individual level information including pharmacy records from nationwide registers. Initiation of standard care post-MI secondary prevention drugs, that is, aspirin, β-blockers, clopidogrel, renin angiotensin system (RAS) blockers and statins, was determined after discharge. In addition, adherence to each drug was evaluated as the proportion of patients on treatment during follow-up and time to first treatment gap.

Results A total of 66 107 MI patients (37% women) were discharged alive; 877 were identified as RA patients (59% women). Thirty days after discharge, RA was associated with significantly lower initiation of aspirin (OR 0.80 (0.67–0.96)), β-blockers (0.77 (0.65–0.92)) and statins (0.69 (0.58–0.82)), while initiation of RAS blockers (0.80 (0.57–1.11)) and clopidogrel (0.88 (0.75–1.02)) was non-significantly reduced. These estimates were virtually unchanged at day 180 and the results were corroborated by Cox regression analyses. Adherence to statins was lower in RA patients relative to non-RA patients (HR for treatment gap of 90 days: 1.26 (1.07–1.48)), while no significant differences were found in adherence to the other drugs.

Conclusions In this nationwide study of unselected patients with first-time MI, a reduced initiation of secondary prevention pharmacotherapy was observed in RA patients. This undertreatment may contribute to the increased cardiovascular disease burden in RA and the underlying mechanisms warrant further study.

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  • Funding JL has received an unrestricted grant from The Danish Rheumatism Association. The funding source had no influence on the study design, interpretation of results, or decision to submit the article.

  • Competing interests None.

  • Ethics approval This study was approved by The Danish Data Protection Agency (ref. 2008-41-2685).

  • Provenance and peer review Not commissioned; externally peer reviewed.