A simplified method for bundling fixed doses of a generic statin and an ACE inhibitor or angiotensin II receptor blocker (ARB) reduced the risk of hospitalization for MI and stroke in 170,024 people aged 55 years and older who had diabetes, coronary artery disease, or both (Am J Manag Care. 2009;15:e88-e94).
Study participants belonged to one of Kaiser Permanente’s two largest groups, i.e., those covering northern and southern California. Members were included if they had taken either statins or ACE inhibitors in 2003 but were excluded if they had received both.
Clinical leaders implemented a medication bundle consisting of a statin (typically lovastatin 40 mg/day) and an ACE inhibitor (typically lisinopril 20 mg/day). Although not part of the study, researchers estimated that 75% of the patients were taking aspirin.
Enrollees were evaluated in three groups: (1) no exposure (no medication bundle [“bundle days”] dispensed); (2) low exposure (1-365 bundle days dispensed); (3) high exposure (366-730 bundle days dispensed).
The investigation revealed a >60% reduction in risk of hos-pitalization for MI or stroke in the year following administration of the bundled medications. Higher exposure to the bundled med- ications resulted in greater risk reduction. The rate of hospital-ization for MI and stroke was 21 per 1,000 members (3,570 adverse cardiovascular events). But in the high-exposure group, the hospitalization rate was lower by 26 per 1,000 members compared with the no-exposure group. The low-exposure group had 15 fewer hospitalizations per 1,000 members than the no- exposure group.
“A bundle consisting of fixed doses of generic statins and [ACE inhibitors or ARBs] reduced the MI and stroke hospitalization rate in a high-risk population,” investigators report. “Our finding is consistent with the well-documented cardioprotective effects of these medications and demonstrates that they can be obtained on a large scale with a simplified regimen, allowing for rapid implementation in populations at risk.”
Although the authors lacked the data to estimate the impact of widely implementing aspirin, lisinopril, and lipid-lowering therapy, conservative assumptions indicate that more than 17,000 MIs and strokes would be avoided in the year after 5.8 million Americans older than age 65 who are predicted to have diabetes by 2010 were exposed to the bundle for 1-365 days over 24 months.