Adherence to guideline-recommended secondary prevention therapy (statins and cardiac rehabilitation) has been demonstrated to reduce the risk of cardiovascular death (RRR 0.22, 95% CI 0.27-0.08) and secondary events. Yet, ≥50% of patients discontinue statin use 12-months after an initial prescription. Low statin adherence limits patients from realizing the full benefits of therapy. In Canada, there is a paucity of research investigating adherence to statins and cardiac rehabilitation post-myocardial infarction (STEMI & NSTEMI) in immigrant and ethnic populations. Understanding variations in adherence may provide new knowledge for the development of clinical interventions, which improve therapeutic adherence within ethnic and immigrant communities. This is a planned retrospective cohort analysis of data collected in the 'Interventions Supporting Long-term Adherence aNd Decreasing cardiovascular events' (ISLAND) randomized clinical trial. The cohort includes patients from nine cardiac centres in Ontario, Canada. Characteristics of the ISLAND cohort (N ∼ 2,742) were stratified by immigration status (Canadian-birth and birth-origin) and duration of time spent living in Canada. The association between time spent living in Canada and immigration status with adherence to guideline-recommended secondary prevention therapy (statins and cardiac rehabilitation) will be analyzed using multivariable regression analysis. The mean age was 65.16 (95% Cl 64.58, 65.75) and was similar between immigration groups. Immigrants were at 36% greater odds of adherence to statin at seven and 30-days compared to Canadian-born participants. When controlling for immigration, age, and smoking history, the odds of statin adherence at 30 days was decreased by 31% (95% CI 3-51) compared to those aged <65. The odds of cardiac completion was not statistically significant but the direction of the effect was weak evidence for reduced odds of cardiac completion in immigrants (OR 0.91, 95% CI 0.72-1.14). Outcomes by ethnicity were reported dichotomously as either White or visual minority. Visual minorities were 33% greater odds (OR 1.33, 95% CI 0.91-1.95) of statin adherence at seven-days. A similar trend in ethnicity was found in 30-day statin adherence outcomes (OR 1.39, 95% CI 0.89-2.18). There was no evidence of ethnicity on cardiac rehabilitation completion (OR 0.98, 95% CI 0.75-1.29). In the final model, neighbourhood income quintile, sex, education, marriage, diabetes, smoking behaviour and age were all predictors of cardiac rehabilitation completion in immigrants. Immigrants and visual minorities demonstrated superior adherence to statins compared to Canadian-born patients. However, this trend did not carry-over to cardiac rehabilitation completion.