Diabetes Self-Management Blog

People at high risk of having a heart attack or stroke can cut their risk by as much as 80% by using a combination of three common medicines — all of them available as generics — according to a recent study published in The American Journal of Managed Care. Heart disease death rates and the risk of stroke are roughly two to four times higher in adults with diabetes than in people without diabetes.

To evaluate the impact of a generic statin (cholesterol-lowering medicine), a generic blood pressure pill, and low-dose aspirin in high-risk individuals, researchers followed 68,560 people over the age of 55 who had diabetes or heart disease and who were not taking the combination of drugs used in the study — a 40-milligram dose of the cholesterol-lowering drug lovastatin and a 20-milligram dose of the blood-pressure-lowering medicine lisinopril. In addition to being prescribed these two drugs, people in the study were encouraged, but not required, to take a daily low-dose (83-milligram) aspirin.

The researchers used prescription records to determine which participants were actually taking the prescribed medicines and how often over the course of a two-year period. (Although aspirin use could not be monitored because it is an over-the-counter medicine, the investigators estimated that roughly 75% of the participants were taking aspirin.)

Results of the one-year follow-up period showed that people who took the two-drug combination as little as 22% of the time reduced their risk of a heart attack or stroke by more than 60%. And those who took the combination at least half the time reduced their risk by roughly 80%. The researchers estimated that 1,271 heart attacks and strokes were prevented in the first year after the treatment period. What’s more, the combination treatment caused no apparent side effects.

According to lead study author R. James Dudl, MD, “This is a proven program that can be applied in many settings to reduce heart attacks and strokes… What was fairly amazing to me was that we got such a good drop in heart attack and strokes despite the low adherence.”

Although lovastatin was the cholesterol-lowering medicine used in the study, the researchers now recommend simvastatin, which has been shown to be even more effective, as part of the three-drug regimen.

For more information, read “Cheap three-drug combination helps cut heart risks” or see the study in The American Journal of Managed Care.

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