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Pravastatin-Aspirin Combination The Medical Need

Pravastatin-Aspirin Combination The Medical Need. Thomas A. Pearson, M.D., Ph.D. Albert D. Kaiser Professor of Community & Preventive Medicine University of Rochester School of Medicine. 7asdf. Consistency of the Efficacy Findings. Combination is more effective than aspirin alone LIPID trial

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Pravastatin-Aspirin Combination The Medical Need

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  1. Pravastatin-Aspirin CombinationThe Medical Need Thomas A. Pearson, M.D., Ph.D. Albert D. Kaiser Professor of Community & Preventive MedicineUniversity of Rochester School of Medicine 7asdf

  2. Consistency of the Efficacy Findings • Combination is more effective than aspirin alone • LIPID trial • CARE trial • meta-analyses of all 5 trials • Combination is more effective than pravastatin alone • LIPID trial • CARE trial • meta-analyses of all 5 trials

  3. Pravastatin-Aspirin Patient Population • Potentially eligible population • all secondary prevention patients • 12.4 million people • Exclusions • contraindication to pravastatin (3%) • contraindication to aspirin (16%) • Eligible population • 10.4 million people Sources: ACC/AHA Guidelines 2001, 2001 Pharmametrics Database, Boston MA

  4. U.S. Heart Disease Prevalence Is Projected to Double in the Next Half Century 24.6 12.4 Sources: ACC/AHA Guidelines 2001, NHLBI Chartbook 2000 and Adapted from Foot et al (JACC 2000)

  5. Medication Recommendations as Supplements to Lifestyle Modification: • Lipid-lowering therapy to achieve LDL-C of <100mg/dL • Antiplatelet therapy, principally aspirin AHA/ACC Guidelines Update in Patients with Atherosclerotic CV Disease • Medication Recommendations as Supplements to Lifestyle Modification: • Lipid-lowering therapy to achieve LDL-C of <100mg/dL • Antiplatelet therapy, principally aspirin • Anti-hypertensive therapy to achieve BP of <140/90 • Hypoglycemic therapy to achieve near normal fasting glucose (HbA1C <7%) • ACE inhibitor • Beta-blocker Source: Circulation (2001) 104: 1577-1579

  6. Components of the Treatment Gap in the Secondary Prevention of Coronary Disease • Many patients face a high pill burden • Many patients fail to receive statins or aspirin • Many patients are not optimally medicated • incorrect doses • incorrect therapy

  7. Following New AHA/ACC Guidelines Necessitates High Pill Burden • A typical secondary prevention patientmight be taking: • statin • aspirin • ACE inhibitor • beta-blocker • A secondary prevention patient with diabetes might also be taking: • oral anti-diabetic agents

  8. Improved Compliance with Combination Tablet vs. Dual Therapy • Diabetes1: • 21% improvement in tablet consumption over 6 month period in previously treated patients • Hypertension: • 13% improvement in tablet consumption over 12 month period2 • 11% improvement in prescription renewal over 12 month period3 • HIV4: • 9% reduction in missing even one dose over 16 week period • 1 White & Hopson (2002) Clin Ther - in press • 2 White & Hopson (2002) in press • 3 Dezii (2000) Manag. Care4 Eron et al (2000) AIDS

  9. Components of the Treatment Gap in the Secondary Prevention of Coronary Disease • Many patients face a high pill burden • Many patients fail to receive statins or aspirin • Many patients are not optimally medicated • incorrect doses • incorrect therapy

  10. Sub-Optimal Usage at Discharge of CV Therapies with Proven Value 167,000 patients nationwide, July ’99 to June ’00. Includes CHD patients with no exclusions for contraindications or intolerance to these drugs. Source: National Registry of Myocardial Infarction -3

  11. Components of the Treatment Gap in the Secondary Prevention of Coronary Disease • Many patients face a high pill burden • Many patients fail to receive statins or aspirin • Many patients are not optimally medicated • incorrect doses • incorrect therapy

  12. Sub-Optimal Use of Efficacious Statin Doses:The LTAP Study • Survey of 4888 patients from 619 primarycare physicians • 1460 patients with diagnosis of CHD • All patients had to be receiving“lipid-lowering therapy” • Statins used in 85% of CHD patients • Doses proven to be efficacious in secondaryprevention trials were seldom used, even in CHD patients Source: Pearson et al: Arch Intern Med (2000)

  13. Sub-Optimal Use of Aspirin in Secondary Prevention • Among those with known cardiovascular disease, only 51% reported they were taking aspirin or an ‘equivalent’ • Of those who thought they were taking aspirin correctly for secondary prevention: • 15% were on non-aspirin analgesic Cook et al, (1999) Med Gen Med, www.medscape.com

  14. Conclusions Pravastatin-Aspirin in CHD Patients: One Prescription – Two Proven TherapiesProven Doses Proven Products • Enhanced implementation of guidelines • Appropriate pravastatin dose; no safety concerns • More appropriate usage of aspirin • Enhanced convenience and reassurance for patients and health care providers

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