'Inexpensive, well-proven medications' could have huge impact, expert says
FRIDAY, Oct. 2 (HealthDay News) -- Giving daily doses of a statin and a blood pressure-lowering ACE inhibitor to people at high risk for a heart attack or stroke reduced their incidence by more than 60 percent in two years, researchers report.
People in the study all had diabetes or a history of cardiovascular disease, but the drug regimen probably could provide similar benefits to anyone vulnerable to cardiovascular trouble because of obesity, high blood pressure or simply old age, said Dr. R. James Dudl, diabetes clinic lead at the Kaiser Permanente Care Management Institute in Oakland, Calif., and lead author of a report in the October issue of the American Journal of Managed Care.
The study was based on a model that assumed that high blood cholesterol and high blood pressure were each responsible for about 25 percent of cardiovascular risk, Dudl said.
"We hypothesized that while there were different mechanisms, the effects are additive," Dudl said. "Our model showed a potential 71 percent drop in cardiovascular risk."
The study was done on a large scale and included 170,024 members of the Kaiser Permanente health plan in California, all aged 55 or older. They were divided into three groups: 21,292 who took the bundled drugs more than half the time in 2004 and 2005, 47,262 who took the drug bundle less than half the time and 101,464 who took neither or just one drug during the study.
Their use of the medications was determined by monitoring their prescription refill records. Participants were also advised to take low-dose aspirin daily, but their use of that medication could not be determined because it is not a prescription drug, Dudl said.
After taking the drugs for two years, the rate of heart attacks and strokes in the next year was reduced by 26 per 1,000 people among those in the high-use group and 15 per 1,000 people in the middle-use group, compared with those in the no-use group, the study found.
"This was accomplished by using three inexpensive, well-proven medications that don't have significant side effects," Dudl said.
The ACE inhibitor used in the study was lisinopril (Prinivil, Zestril), given at 20 milligrams a day, and the statin was lovastatin (Altoprev, Mevacor), given at 40 milligrams daily, but any combination of drugs in the two families could be used, Dudl said. "We feel that these are class actions, not specific to any one drug," he said.
The program has since been extended to include more than 256,000 Kaiser Permanente members across the country and is being offered in community health centers, a company spokesman said.
"However the atherosclerotic process is advanced, we feel that these treatments would work," Dudl said. Atherosclerosis is the hardening of arteries that can lead to a heart attack, stroke or other cardiovascular problem. "We went for people with the highest risk, but the program could benefit anybody with the atherosclerotic process caused by any mechanism, particularly hypertension [high blood pressure]."
Dr. Michael A. Blazing, an associate professor of medicine and cardiology at Duke University, said that the study confirms in one large sweep what has been seen in smaller studies of individual preventive drug treatments.
"The key is bundling the drugs and the distribution system," Blazing said. "Much of the effect is due to getting the drugs to the population that needs them. What they are doing is validating the bits and pieces that have been shown in different studies in different ways. They are also validating the work that shows that individuals who stay on these drugs do better."
The study also has meaning for the current drive to establish a national health insurance program, he said.
"It means that if you do better delivery to large populations, they do better," Blazing said. "It's a kind of model we need to be looking at for the overall health-care debate that is going on."
The American Heart Association has more on risk factors for coronary heart disease.
SOURCES: R. James Dudl, M.D., diabetes clinic lead, Kaiser Permanente Care Management Institute, Oakland, Calif.; Michael A. Blazing, M.D., associate professor, medicine/cardiology, Duke University, Durham, N.C.; October 2009 American Journal of Managed Care
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