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Drug combinations improve survival in heart disease
May 6, 2005, 16:43, Reviewed by: Dr.
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The study involved over 13,000 patients who were diagnosed with ischaemic heart disease between 1996 and 2003. Cases were patients with heart disease who died, while controls were patients with heart disease who were matched for age, sex, and year of diagnosis and were alive at the time their matched case died.
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By BMJ-British Medical Journal ,
Patients with coronary heart disease who take a combination of three specific drugs have a better chance of survival than those taking single drugs, finds a study in this week's BMJ.
This is the first large scale, long term trial to report the effect of different combinations of drugs to prevent deaths in patients with heart disease,
The study involved over 13,000 patients who were diagnosed with ischaemic heart disease between 1996 and 2003. Cases were patients with heart disease who died, while controls were patients with heart disease who were matched for age, sex, and year of diagnosis and were alive at the time their matched case died.
Treatments associated with the greatest reduction in deaths (83%) were statins (cholesterol lowering drugs), aspirin, and beta-blockers (a type of blood pressure lowering drug). Adding another type of blood pressure lowering (an angiotensin converting enzyme inhibitor) conferred no additional benefit.
Treatments associated with the smallest reduction were beta-blockers alone (19%) and angiotensin converting enzyme inhibitors alone (20%).
Combinations of statins, aspirin, and beta-blockers improve survival in high risk patients with cardiovascular disease, say the authors.
It has previously been proposed that these three treatments, along with folic acid, be combined into a "polypill" to be taken daily by everyone from age 55. These results support the synergic action of the polypill for people with pre-existing heart disease, but provide no evidence that it should be prescribed to all patients over 55, they conclude. 
- Effect of combinations of drugs on all cause mortality in patients with ischaemic heart disease: nested case-control analysis BMJ Volume 330, pp 1059-63/Editorial: The polypill and cardiovascular disease BMJ Volume 330, pp 1035-6
www.bmj.com
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