Drug duo can lower heart attacks and strokes
An inexpensive combination of one drug to lower cholesterol and one to lower blood pressure can reduce the incidence of heart attacks and strokes by as much as 60% -- but getting patients to begin the regimen and then to stay on it is an extremely difficult task, Kaiser Permanente researchers reported Thursday.
Giving the drugs to nearly 70,000 people with cardiovascular disease or diabetes prevented an estimated 1,271 heart attacks and strokes in one year, Dr. James Dudl of Kaiser Permanente’s Care Management Institute and his colleagues reported in the American Journal of Managed Care.
The inspiration for the study came from the Archimedes Model, a sophisticated computer simulation of the human body that predicted that lowering blood pressure and cholesterol simultaneously in those at the highest risk for cardiovascular problems could reduce the incidence by 71%. But no study had been performed to test the prediction.
The Kaiser team chose two generic drugs, lovastatin for cholesterol and lisinopril for blood pressure, and offered them to 170,000 members of their managed-care programs in Northern and Southern California who suffered from heart disease or diabetes.
Some of the patients were already taking one of the drugs, but none of those selected was taking both.
About 75% were also taking daily aspirin, but the researchers did not include aspirin in the protocol because they had no way to monitor usage.
They began the program in 2004 with nearly 70,000 patients. The team monitored compliance for two years by checking whether and how often patients refilled their prescriptions, then monitored health effects in the third year through the patients’ health records.
Some 47,268 patients had what the team termed “low exposure” to the drugs, taking them less than half the time. Their risk of hospitalization for heart attack or stroke was lowered by 15 events per 1,000 person-years, and an estimated 726 events were prevented. Person-years is the sum of years of treatment of all patients.
An additional 21,292 patients had “high exposure” to the drugs, taking them more than half the time. Their risk was reduced by 26 events per 1,000 person-years, preventing an estimated 545 events.
“What was fairly amazing to me was that we got such a good drop in heart attack and strokes” despite the low adherence, Dudl said. “The issue now is how to increase adherence.”
The primary reasons for nonadherence, according to Dudl, were things like, “I don’t know why I was taking the drugs,” “I forgot to refill the prescription,” and “I worry about side effects.”
Kaiser now has a follow-up program focused on adherence, Dudl said.
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