One Pill for Everyone? Twenty Years of Polypill for Cardiovascular Disease

Wald and Law estimated that a combination of a statin, thiazide diuretic, β blocker, angiotensin converting enzyme (ACE) inhibitor, folic acid, and aspirin could reduce ischemic heart disease events and stroke by 88% and 80%, respectively.1 Because rates of cardiovascular disease (CVD) remain high w...

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Bibliographic Details
Published in:The American journal of cardiology 2023-09, Vol.203, p.493-495
Main Author: Tran, Rebecca J.C.
Format: Article
Language:English
Subjects:
Angiotensin
Angiotensin-converting enzyme inhibitors
Antihypertensives
Aspirin
Blood pressure
Calcium channel blockers
Calcium channels
Cardiovascular disease
Cardiovascular diseases
Cholesterol
Clinical trials
Density
Dihydropyridine
Disease prevention
Diuretics
Folic acid
Health services
Heart
Heart diseases
Ischemia
Lipids
Meta-analysis
Myocardial infarction
Peptidyl-dipeptidase A
Population
Prevention
Receiving
Sensitivity analysis
Statins
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Summary:Wald and Law estimated that a combination of a statin, thiazide diuretic, β blocker, angiotensin converting enzyme (ACE) inhibitor, folic acid, and aspirin could reduce ischemic heart disease events and stroke by 88% and 80%, respectively.1 Because rates of cardiovascular disease (CVD) remain high worldwide, the polypill or fixed dose combination strategy is viewed as a potential method to reduce barriers to adequate medical care. Nonadherence to medication therapy is common and associated with poor outcomes in the population receiving secondary prevention.2 By simplifying medication regimens, the polypill strategy significantly improves patient adherence to prescribed therapies.3 In the prevention or treatment of CVD, the polypill strategy reduces surrogate end points such as blood pressure and low-density lipid low-density lipoprotein-cholesterol levels.4 More importantly, large clinical trials have shown that polypills reduce clinical outcomes such as a composite of major adverse cardiovascular events. Dihydropyridine calcium channel blockers also reduce blood pressure to a greater extent in Eastern Asians.13 In the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack) trial, cardiovascular outcomes were greater in Black participants randomized to ACE inhibitors than among those receiving a calcium channel blocker or thiazide diuretic.14 Therefore, healthcare providers should consider ethnic and racial differences when prescribing polypills in a diverse population.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2023.06.106