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Three Inexpensive Drugs Reduce Heart Attack, Stroke Risks


People who are at high risk of experiencing a heart attack or stroke can reduce their risk by up to 80 percent if they take a combination of three inexpensive drugs, according to a new study published in the online journal American Journal of Managed Care. The study was conducted by Kasier Permanente.

People who have heart disease and/or diabetes, two of the most common and deadly diseases in the United States, are at high risk of having a heart attack or stroke. An estimated 23.6 million people have diabetes, according to the American Diabetes Association, and these individuals have heart disease death rates and risk for stroke about 2 to 4 times higher than adults without diabetes. Heart disease and stroke account for about 65 percent of deaths in people who have diabetes.

It has long been known that statins (blood pressure reducing medications) and angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs) individual reduce the risk of heart attack and stroke. The current study was the first to investigate whether a consistent process to deliver a combination of these drugs to a large population of people who have diabetes and/or heart disease in the community, and also to measure the impact of this approach on the occurrence of heart attack and stroke.

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The two-year treatment period of the study involved 68,560 individuals older than age 55 who had diabetes or heart disease who were not currently taking the combination of drugs used in the study: a cholesterol-lowering statin (40 mg lovastatin) and a blood pressure-lowering drug (20 mg lisinopril). The participants were to take these drugs daily, and were also encouraged but not required to take a low-dose aspirin (83 mg).

The investigators checked prescription records to determine which patients were taking their medications and how often. Although aspirin use could not be monitored because it is over-the-counter, the investigators estimated that about 75 percent of participants were already taking aspirin. During the follow-up period, researchers found that individuals who took both drugs as little as 22 percent of the time reduced their risk of hospitalization for heart attack or stroke the following year by more than 60 percent. Patients who took both drugs at least half of the time reduced their risk by about 80 percent. An estimated 1,271 heart attacks and strokes were prevented in the first year following the treatment period.

Results of this study show that not only is an impressive reduction in heart attack and stroke possible when patients with heart disease or diabetes take a combination of three readily available drugs, but that the two prescription drugs can be generics, which are significantly less expensive than brand names. Even though the study team now recommends a reportedly more effective statin - simvastatin - rather than lovastatin, the reduction in heart attack and stroke were significant when the latter drug was used.

American Diabetes Association
Dudl RJ et al. American Journal of Managed Care published online October 1, 2009; 15(10):e88-e94
Reuters, October 1, 2009