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Four-drug cocktail can reduce death risk of heart patients

Patient Safety Monitor Alert, February 18, 2004

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Heart attack and unstable angina patients who were prescribed all four medications had a 90% lower risk of dying in the six months after they left the hospital than those who received none of the drugs, reports a paper by U-M Cardiovascular Center researchers.

Patients who received only two or three of the drugs also had a much lower death risk than those who received none. The research is published in Circulation, the Journal of the American Heart Association (http://circ.ahajournals.org).

The four classes of medications are:

• Anti-platelets: Aspirin and other drugs 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

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. 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 drugs 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.

"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," says lead author and U-M cardiologist Debabrata Mukherjee, MD "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."

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