Patients with coronary heart disease (CHD) often receive combination drug therapy, but the effects of specific combinations are not well documented. In this study, researchers evaluated combinations of four drugs (statins, angiotensin-converting–enzyme [ACE] inhibitors, aspirin, and ß-blockers) using a U.K. database that included information on nearly 1.2 million patients (5 million person-years). Researchers identified 13,029 patients in whom CHD was diagnosed on or after January 1, 1996. Cases were the 2266 patients who died during follow-up (through December 17, 2003), and controls were 9064 patients (matched for age at diagnosis, year of diagnosis, and sex) who were alive when their matched cases died.
After adjustment for comorbidities and other risk factors, the following drug combinations were associated with the largest reductions in odds for all-cause mortality:
The following treatments were associated with the smallest reductions in odds for mortality:
These findings validate the current practice of providing combination drug therapy to high-risk patients with CHD. The combination that provided the most benefit in this analysis involved aspirin, a statin, and a ß-blocker, but not an ACE inhibitor. However, the exclusion of an ACE inhibitor from this combination might not be convincing to many observers, because results from randomized trials clearly have demonstrated beneficial effects of ACE inhibitors in various subgroups of patients with CHD. At the time of publication, the full text of the original article was available free of charge.
Reference:
Hippisley-Cox J and Coupland C. Effect of combinations of drugs on all cause mortality in patients with ischaemic heart disease: Nested case-control study. BMJ 2005 May 7; 330:1059-63.