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Low-Cost Drugs Prevent Heart Attack, Stroke

Study Shows Generic Statins and Blood Pressure Drugs Cut Risk of Hospitalization
By
WebMD Health News
Reviewed by Louise Chang, MD

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 study.

''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 disease.

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 habits.
  • 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 participants.

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