Debabrata Mukherjee, M.D., FACC, a cardiologist with the University of Michigan Health System in Ann Arbor, led a study that found that patients who are given all four recommended medications at once after having a heart attack or acute cardiac event are 90 percent more likely to be alive six months later than those who are given none.
This is the first study on how combining proven medical treatment for heart attacks and angina affects death. "We already know that these drugs work very well individually," Mukherjee said. "Our results indicate that the drugs work even better when they are used together in appropriate patients."
The study focused on the use of four types of drugs that individually have been shown to reduce the risk of death in patients with acute coronary syndromes: anti-platelet agents (which inhibit clot formation); beta-blockers and angiotensin converting enzyme (ACE) inhibitors (blood pressure drugs that also have other beneficial effects); and statins (the most widely used cholesterol-lowering drugs). The impact of combining these drugs, when indicated, has not been studied extensively, Mukherjee said.
Researchers evaluated the patients for their appropriateness to receive each of the four medications based on American Heart Association and the American College of Cardiology guidelines. Upon discharge from the hospital, patients were given from none to all four of the drugs.
The main goal of the study was to determine the impact of treatment on mortality six months after hospital discharge. For the patients who received all four drugs, the risk of dying within six months was reduced by 90 percent. The risk of dying was reduced by 83 percent for those who received three drugs, and 82 percent for those receiving two. Patients who received just one of the four indicated drugs had a 64 percent lower risk of death in six months compared to those who took no medications after discharge.
Mukherjee notes that the drugs do not cause known adverse interactions with one another, and each type of drug is available in an inexpensive generic form.
Work that lead to this breakthrough research began in the 1990s with two AHA postdoctoral fellowship awards from the Ohio Valley Affiliate. "My AHA fellowship supported research doing pre-clinical studies on benefits of ACE inhibitors and beta-blockers in myocardial hypertrophy and heart failure. The current study is a clinical extension of the prior animal and pathological studies funded by AHA," Mukherjee said.