Pill Combo May Do More to Reduce Stroke Risk
THURSDAY, Jan. 25, 2018 -- A special combination of cholesterol- and blood pressure-lowering pills may be best at cutting the odds of stroke for people at high risk, new research shows.
Taking daily doses of two blood pressure medications and a cholesterol-lowering drug reduced first-time strokes by 44 percent among people at risk for heart disease, researchers found.
The combination worked better than either type of medication did on its own, said lead researcher Jackie Bosch. She's a professor of rehabilitation science at McMaster University in Hamilton, Ontario.
Based on these results, the researchers are now looking at developing a single combo pill that would lower both blood pressure and cholesterol, Bosch said.
"Results of this study definitely gave us a little oomph in our step as we move forward in this concept, that we might be on the right track," Bosch said of ongoing "polypill" research.
The clinical trial involved just over 12,700 people from 21 countries, all of whom were healthy but had risk factors for future heart disease, Bosch said. The average age was 66, placing the group primarily in late middle age.
Participants were randomly inserted into one of four groups assigned to take different daily regimens:
- Blood pressure drugs candesartan and hydrochlorothiazide.
- Cholesterol drug rosuvastatin (Crestor).
- Both the blood pressure and cholesterol drugs.
- A "dummy" placebo pill.
Interestingly, the blood pressure drugs had the least benefit of the medication regimens, reducing strokes overall by a statistically insignificant 20 percent, the findings showed.
"We kind of thought that one was going to be the shoo-in -- blood pressure-lowering and stroke -- and it didn't turn out to be significant," Bosch said.
Blood pressure drugs did, however, help people with a very high blood pressure level of 143.5 systolic or higher, reducing stroke in this particular group by 42 percent, the investigators found.
Cholesterol-lowering rosuvastatin had a greater impact, reducing strokes by 30 percent, Bosch said. The drug particularly helped prevent strokes caused by blood clots.
But the blood pressure and cholesterol drugs appeared to work best when taken together, driving down first-time strokes by 44 percent.
The results fall in line with what the researchers anticipated, although the main driver behind the benefit was different than expected, Bosch said.
"The 44 percent isn't unexpected, but it is largely driven by the cholesterol-lowering effect, and that's something people need to consider," Bosch noted.
Many middle-aged people take blood pressure and cholesterol drugs, but as far as Bosch knows, they aren't prescribed as a combination therapy. Instead, they are prescribed based on a person's vital signs, given to people with high blood pressure or elevated cholesterol.
"We think it should be a popular combination. We think it's the better way to go," Bosch said.
According to Dr. Richard Libman, vice chairman of neurology at Long Island Jewish Medical Center in New Hyde Park, N.Y., the study "shows scientifically what everybody kind of thought anyway" about the effect of reducing stroke risk factors.
"It is the first time to my knowledge that it's been shown you can take patients who have never had a stroke but have risk factors, and putting them on these drugs that are widely used and showing you can prevent a first stroke," Libman said.
Seventy-five percent of strokes are first-time strokes, and stroke is the fifth-leading cause of death in the United States, the study authors noted in an American Heart Association news release.
Clinical trials are underway testing a polypill that lowers blood pressure and cholesterol at the same time, Bosch said.
Such a pill could improve the rate at which patients stick to their medication, she suggested.
"You only have to take one medication daily versus taking three or two," Bosch said. "We think it will be beneficial for patients, because no one wants to take little doses of six pills every morning."
But, Libman said, cost could be a factor. The drugs used in this clinical trial have all been on the market for some time, and cheap generic versions are available. A single, brand-name pill would be easier to take on schedule, but would likely cost more.
"It's kind of a double-edged sword," Libman said. "I think as soon as you put it into one medication, you are dramatically increasing adherence. My fear is if it becomes branded and the price goes up a hundred times, you will only be increasing adherence in the smaller portion of the population who can afford it."
Bosch presented her team's findings Thursday at the American Stroke Association's annual meeting in Los Angeles. Research presented at meetings is considered preliminary until it is published in a peer-reviewed journal.
For more on stroke, visit the American Heart Association.
Posted: January 2018