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Bundled medication associated with reduced risk for CV hospitalization
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The bundled combination of 40-mg lovastatin and 20-mg lisinopril was associated with reduced risk for hospitalization for MI and stroke in patients with coronary artery disease.
Researchers for the observational study enrolled 170,024 patients diagnosed with CAD who were not assigned to the bundle of a generic statin and an ACE inhibitor/angiotensin receptor antagonist. Among those, 47,268 (27.8%) had low exposure to either medication (one to 365 days of bundle exposure) in 2004 and 2005, and 21,292 (12.5%) had high exposure (366 to 730 days of bundle exposure). There were 101,464 (59.7%) patients with no bundle exposure.
The researchers reported a hospitalization rate for MI and stroke of 21 events per 1,000 person-years (3,570 adverse CV events) in 2006. In patients with low two-year exposure to the medication bundle, the rate of hospitalization for MI and stroke decreased (–15 events per 1,000 person-years; 95% CI, –30 to –1) vs. those with no bundle exposure. Patients with high two-year bundle exposure also saw a decrease in the rate of MI and stroke (–26 events per 1,000 person-years; 95% CI, –34 to –17), reflecting a reduction of 545 events (95% CI, 361-728) vs. those with no bundle exposure. The occurrences of MI also decreased among those with high bundle exposure (–209; 95% CI, 21-397) vs. those with low bundle exposure (60; 95% CI, –607 to 726). The researchers also reported that among patients with low bundle exposure, the rate of percutaneous transluminal coronary angiography was lower by 15 events per 1,000 person-years (95% CI, 6-24) vs. those with no bundle exposure.
“It is no surprise that if you give ACE inhibitors or statins that you are going to reduce CV events,” Marc Jaffe, MD, an endocrinologist at the South San Francisco Medical Center and clinical leader for the Northern California CV Risk Reduction Program for Kaiser Permanente, told Cardiology Today. “What is fascinating is that two generic medications can be effectively delivered to a very large population and produce the effects that we expect to reproduce. By bundling together these two safe, effective, affordable medications, we can dramatically reduce the risk for CVD in a short period of time.”
Dudl RJ. Am J Manag Care. 2009;15:e88-e94.