DRUG COMBO SAVES THE HEART
According to the national institutes of health, about one million Americans will have a heart attack every year. More than half of those people will survive, but not all of them will leave the hospital with the drugs they need to keep them alive. Here's what drugs patients need to keep their hearts on the right track.
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Today, Dick Croake is recovering from a heart procedure that cleared a 90-percent blocked artery.
Dick Croake
Had blocked artery
"The physician who did the procedure said, 'If you hadn't come in, something bad would have happened.'"
To prevent a heart attack, Dick is taking a quartet of drugs.
Dick Croake
"I feel a bit like a chemical broth at the moment."
Cardiologist Debabrata Mukherjee says it's a smart step.
Debabrata Mukherjee, M.D.
Interventional Cardiologist
University of Michigan
Ann Arbor, MI
"There are four classes of drugs that are currently recommended in all patients that present to the hospital either with worsening chest pain or with a heart attack."
Those drugs are: ace inhibitors to lower blood pressure; statins to lower cholesterol; anti-platelets, which include aspirin and plavix; and beta-blockers, which lower blood pressure but have other benefits too.
Debabrata Mukherjee, M.D.
"All four should be started at once, rather than individually one at a time."
Doctors know each of the drugs is important, but they didn't realize the cumulative effect of taking all four until now. A new study shows taking all four lowers the risk of death more than 90 percent after six months.
The American Heart Association recommends the drugs for heart patients, but that doesn't always happen.
Debabrata Mukherjee, M.D.
"There is still a gap between optimal care of patients and what is recommended in the guidelines."
Doctor Mukherjee tells heart patients to ask their doctors about the drugs. Dick feels safer knowing he's getting the best care.
Dick Croake
"I feel guardedly optimistic. I said to my wife this morning, 'It is great to be alive.'"
Now, he's focusing more on the scenery and less on his heart.
All of the recommended drugs are available in generic forms. Even without insurance, the drugs should cost no more than $50 a month. They are recommended for prevention of a second heart attack, for those who have already had one, or for those who have a history of heart disease. Side effects may occur in some people, so be sure to discuss each of the drugs with your doctor.
POWERFUL PUNCH TO THE HEART: A new study published in the journal Circulation shows an inexpensive cocktail of four tiny pills can make a big difference in heart patients' risk of death and the life-saving effect of the four-drug regimen is bigger than the sum of its parts. Researchers from the University of Michigan say heart attack and unstable angina (chest pain) patients who were prescribed all four types of medications proven to be effective alone had a 90-percent lower risk of dying in the six months after they left the hospital than those who received none of the drugs. Even patients who were given only two or three of the drugs had a much lower death risk than those who didn't get any.
THE FOUR FIGHTERS: Many studies have already shown that individual drugs in each one of the four classes can help prevent problems in patients with previous heart problems and clogged arteries. All four are recommended in national guidelines for doctors, and all four classes of drugs include many individual medications, with at least some available in inexpensive generic form. The four drugs are:
ANTI-PLATELETS: Aspirin and other drugs, like Plavix, that keep blood clots from forming
STATINS: Cholesterol-lowering drugs
ACE INHIBITORS: Blood pressure-lowering drugs that have other beneficial effects
BETA-BLOCKERS: Adrenaline-blocking drugs that ease the burden on the heart. They also lower blood pressure.
THE DETAILS: The new study is the first to show the power of the four types of drugs together, and it does so in a "real world" setting of 1,264 adult patients treated between 1999 and 2002. All of the patients had been admitted to the hospital with an acute coronary syndrome: either heart attack or unstable angina. Researchers say the results were surprising. Debabrata Mukherjee, M.D., from the University of Michigan, says, "We knew that each of these kinds of drugs works pretty well alone, but we never expected that together they would be this powerful at improving survival. These results clearly show that the effect of combination therapy is synergistic, not just additive: the drugs work together to create a bigger benefit for the patient." Researchers say this amplified effect may stem from a combination of the different ways in which the four types of drugs fight the plaque that builds up in arteries.
The bottom line for patients, Dr. Mukherjee says, is that people who have a history of heart attack or unstable angina should talk with their doctor about making sure they receive prescriptions for as many of the four types of medications as they are eligible for. And, he notes, they should ask for generic drugs whenever possible. If all four drugs in the cocktail are generic, the total cost may be under $50 a month.
GUIDELINES IGNORED? The American Heart Association already recommends all four drugs for heart patients. Despite those guidelines, not all heart attack and unstable angina patients get prescribed all the drugs they should. One of the four drugs was prescribed to all eligible patients, and 40 percent of patients who could have received ACE inhibitors were not receiving them. About 5 percent lacked an aspirin prescription, almost 18 percent did not get beta-blockers, and 16 percent weren't prescribed statins.
Kara Gavin
Public Relations
University of Michigan Health System
Ann Arbor, MI
kegavin@umich.edu
Copyright © 2004 Ivanhoe Broadcast News, Inc.
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