# Presentation: 278818

## 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**

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## Consistency of the Efficacy Findings

**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**

## Pravastatin-Aspirin Patient Population

**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**

## U.S. Heart Disease Prevalence Is Projected to Double in the Next Half Century

**Sources: ACC/AHA Guidelines 2001, NHLBI Chartbook 2000**
**and Adapted from Foot et al (JACC 2000)**

**12.4**

**24.6**

**U.S. Heart Disease Prevalence Is Projected to Double in the Next Half Century**

## AHA/ACC Guidelines Update in Patients with Atherosclerotic CV Disease

**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 (HbA****1C**** <7%)**
**ACE inhibitor**
**Beta-blocker**

**AHA/ACC Guidelines Update in Patients ****with Atherosclerotic CV Disease**

**Source: Circulation (2001) 104: 1577-1579 **

## Components of the Treatment Gap in the Secondary Prevention of Coronary Disease

**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**

## A typical secondary prevention patientmight be taking:
statin
aspirin
ACE inhibitor
beta-blocker
A secondary prevention patient with diabetes might also be taking:
oral anti-diabetic agents

**statin**
**aspirin**
**ACE inhibitor**
**beta-blocker**
**A secondary prevention patient with diabetes might also be taking:**
**oral anti-diabetic agents**

**Following New AHA/ACC Guidelines Necessitates High Pill Burden**

## Improved Compliance with Combination Tablet vs. Dual Therapy

**Diabetes****1****:**
**21% improvement in tablet consumption over 6 month period in previously treated patients**
**Hypertension:**
**13% improvement in tablet consumption over 12 month period****2**
**11% improvement in prescription renewal over 12 month period****3**
**HIV****4****:**
**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. Care**4 **Eron et al (2000) AIDS**

## Components of the Treatment Gap in the Secondary Prevention of Coronary Disease

**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**

## Sub-Optimal Usage at Discharge of CV Therapies with Proven Value

**Sub-Optimal Usage at Discharge of CV Therapies with Proven Value**

**Source: National Registry of Myocardial Infarction -3**

**167,000 patients nationwide, July ’99 to June ’00.**
**Includes CHD patients with no exclusions for contraindications or intolerance to these drugs.**

## Components of the Treatment Gap in the Secondary Prevention of Coronary Disease

**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**

## Sub-Optimal Use of Efficacious Statin Doses:The LTAP Study

**Survey of 4888 patients from 619 primary****care 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 secondary****prevention trials were seldom used, even in CHD patients**

**Source: Pearson et al: Arch Intern Med (2000)**

## 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**

## Conclusions

**One Prescription – Two Proven Therapies****Proven Doses**** Proven Products**

**Conclusions**

**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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