New Evidence on Polypill: from CVD Risk Factor Control to Mortality Reduction

polypill iran

The polypill is actually a pill that contains a combination of various drugs commonly used to treat heart disease, dyslipidemia and high blood pressure. Recently, an article from the PolyIran study was published in The Lancet that attracted the attention in media and scientific communities.

The PolyIran study (a two-group, pragmatic, cluster-randomized trial nested within the Golestan Cohort Study) aimed to assess the effectiveness and safety of a four-component polypill including Aspirin, atorvastatin, hydrochlorothiazide, and either enalapril or valsartan for primary and secondary prevention of cardiovascular disease in a study population of 6836 individuals. The primary outcome was the occurrence of major cardiovascular events (including hospitalization for the acute coronary syndrome, fatal myocardial infarction, sudden death, heart failure, coronary artery revascularisation procedures, and non-fatal and fatal stroke).
During follow-up, 301 (8·8%) of 3417 participants in the minimal care group had major cardiovascular events compared with 202 (5·9%) of 3421 participants in the polypill group (adjusted hazard ratio [HR] 0·66, 95% CI 0·55–0·80). When restricted to participants in the polypill group with high adherence, the reduction in the risk of major cardiovascular events was even greater compared with the minimal care group (adjusted HR 0·43, 95% CI 0·33–0·55).
The authors concluded that the use of polypill was effective in preventing major cardiovascular events and the polypill strategy could be considered as an additional effective component in controlling cardiovascular diseases, especially in LMICs.

In another small but still valuable study, some 300 adults without cardiovascular disease (CVD) at a community health center in Alabama were randomized either to take a daily pill containing low-dose atorvastatin, amlodipine, losartan, and hydrochlorothiazide, or to receive usual care. Eligible people had systolic BP of at least 120 mm Hg and an LDL of less than 190 mg/dL. At baseline, mean systolic BP was 140 mm/Hg and the mean LDL was 113 mg/dL. Some 96% were black; roughly three-quarters had household incomes below $15,000/year.

At 12 months, mean systolic BP had decreased by 9 mm Hg with the polypill versus 2 mm Hg with usual care; the mean LDL level decreased by 15 mg/dL vs. 4 mg/dL. After multivariable adjustment, the polypill was associated with significantly greater improvements in both outcomes.

This study was published in the New England Journal of Medicine and the researchers wrote that “such changes, if sustained, would lead to an approximate 25% reduction in the incidence of cardiovascular events.”

Read the PolyIran article here.

Read the American article here.

Sources: The Lancet, New England Journal of Medicine and NEJM Journal Watch

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