Low-Cost Drugs Prevent Heart Attack, Stroke
Study Shows Generic Statins and Blood Pressure Drugs Cut Risk of Hospitalization
Oct. 1, 2009 -- Giving two low-cost prescription drugs to reduce cholesterol
and blood pressure in people with diabetes or heart disease -- along with
encouraging them to take a daily aspirin -- can slash their risk of
hospitalization for heart attack or stroke by 60%, according to a new
''If you have diabetes or heart disease, the biggest killer is likely to be
a heart attack or stroke," says study researcher Robert James Dudl, MD, the
director of the diabetes program at the Kaiser Permanente Care Management
Institute in Oakland, Calif.
While researchers have previously shown that cholesterol-lowering statins
and blood-pressure-lowering drugs taken individually reduce strokes and heart
attacks, their combined effectiveness in large populations is not documented,
Dudl and colleagues note.
So the researchers studied a new, simplified approach in which everyone was
given a standard dose of the statin and blood-pressure-lowering drugs, rather
than the common practice of starting people out on a low dose and monitoring
and adjusting the dose several times.
For the study, the researchers tracked more than 170,000 members of the
Kaiser Permanente health plan in California who had heart disease or were over
55 with diabetes -- or had both conditions.
In all, 77.8% had diabetes with or without heart disease, while 31.7% had
heart disease only. The median age was 68 (half were younger, half older).
Besides being encouraged to take a daily aspirin, patients were prescribed a
medication bundle, typically lovastatin (40 milligrams a day) to lower
cholesterol and lisinopril (20 milligrams a day) to lower blood pressure.
During an initial doctor's office visit, patients were asked about medical
history to rule out reasons they shouldn't be on the drugs, such as liver
Next, patients were divided into three groups:
- 21,292 participants were in the high-exposure group, taking the drugs more
than half the time in 2004 and 2005, based on their prescription refill
- 47,268 people were in the low-exposure group, taking the drugs less than
half the time during 2004 and 2005.
- 101,464 people were in the no-exposure group, taking neither drug or just
one of the two prescription drugs during 2004 and 2005.
The aspirin could not be tracked through prescription records.
Reducing Risk of Heart Attacks and Strokes
The risk reduction in heart attacks and strokes varied by group and how
faithfully participants took the medications.
Compared with the no-exposure group, the low-exposure group (whose members
picked up medicines less than half the time) had a 60% reduction in
hospitalizations for heart attack and stroke.
''People who picked up the medicine more than half the time had more than a
60% reduction in heart attack and stroke in the third year of follow-up," says
Marc Jaffe, MD, director of the Kaiser Permanente Northern California
Cardiovascular Risk Reduction Program, who oversaw more than half the study