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.
