• Combination of Medications for Cardiovascular Disease Does Not Reduce Mortality

    Cardiovascular disease is a term that includes coronary artery disease , heart attack , and stroke . They are collectively responsible for 40% of all US deaths. Some preventive drug therapies have been able to decrease risk factors like high blood pressure . Medications such as ACE-inhibitors or angiotensin receptor blockers (ARB) are common choices.
    Ongoing studies continue to determine the most effective drug or drug combination to decrease risks of cardiovascular disease. In a recent study, researchers compared the benefits of combining an ACE-inhibitor and an ARB, to the benefits of the individual drugs. The study, published in the New England Journal of Medicine , found that there was no added benefit to using a combination of these drugs. In fact, there may be some negative side effects.

    About the Study

    The research was done at the Population Health Research Institute in McMaster University. Researchers studied 25,620 patients (without heart failure ) with coronary, peripheral, or cerebrovascular disease or diabetes with end-organ damage. Patients were randomly assigned to one of three groups:
    • Group 1 took ramipril (ACE inhibitor)
    • Group 2 took telmisartan (ARB)
    • Group 3 took a combination of both medications
    They were then followed for almost five years. Researchers compared the three groups for:
    • Number of deaths (any cause)
    • Cardiovascular illness or death
    • Myocardial infarction (heart attack)
    • Stroke
    • Rates of hospitalization for heart failure
    There was no significant difference between the groups. The combination group was associated with higher incidence of renal (kidney) impairment compared to ramipril. The consequence of the renal impairments are not clear.

    How Does This Affect You?

    A common side effect of ACE inhibitor is cough , so your doctor may switch you to an ARB. They have the same benefit. However, a combination of the drugs may cause more harm than good. As medication options increase, you may find yourself with multiple prescriptions. This can sometimes lead to confusion and costly errors. Make sure to talk to your doctor and clarify the addition of any medication.
    Lifestyle habits are also important in decreasing your risk for cardiovascular disease. Maintain a healthy weight, do not smoke, get at least 30 minutes of physical activity every day, monitor blood pressure and cholesterol levels, and eat a well-balanced diet.


    American Heart Association http://www.americanheart.org

    National Women Health Information Center http://www.womenshealth.gov/


    Cardiovascular disease statistics. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4478 . Accessed May 2, 2008.

    Yusuf S, Teo KK, Pogue J, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med . 2008 Apr 10;358(15):1547-59. Available at: http://www.ncbi.nlm.nih.gov/sites/entrez . Accessed April 30, 2008.

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