A lthough recent studies indicate a reduction in incidence, 1 coronary heart disease (CHD) remains the leading cause of death in Spain 2 and other developed countries.3 Numerous large-scale prospective randomized trials involving hundreds of thousands of patients have documented the efficacy and safety of several treatments for patients with myocardial infarction (MI) and other forms of acute coronary syndrome (ACS). Practice guidelines recommend that, unless a relevant contraindication exists, post-MI patients receive Pharmacological secondary prevention in patients after an acute coronary syndrome (ACS) has contributed substantially to reductions in cardiovascular morbidity and mortality and, overall, has undergone important improvements in recent years. Nevertheless, there is still a considerable adherence gap and opportunity for improvement.

HCV/HIV coinfection has had a large impact on mortality in IDU. After 1997, mortality increased in HIV negative/HCV positive subjects and decreased in HIV positive/HCV positive.

Since the mid-1990s important decreases in tuberculosis have been observed in HIV-seroconverters that probably reflect the impact of both HAART and tuberculosis control programmes.

Independently of HIV status, lower education predicts a higher risk of death in IDUs and its impact is stronger after 1997. Education has a protective effect on most causes of death and it cannot be entirely attributable to the access or use of HAART.

Cardiovascular and cancer mortality are increasing among IDUs, but the increases are not related to HIV infection. We have not found a link between highly active antiretroviral therapy (HAART) introduction and increases in mortality for specific causes.