The effects of fixed-dose combination therapy on all-cause mortality or ASCVD events are uncertain .
A limited number of trials reported these outcomes , and the included trials were primarily design ed to observe changes in ASCVD risk factor levels rather than clinical events , which may partially explain the observed differences in risk factors that were not translated into differences in clinical outcomes among the included trials .
Fixed-dose combination therapy is associated with modest increases in adverse events compared with placebo , active comparator , or usual care but may be associated with improved adherence to a multidrug regimen .
Ongoing , longer-term trials of fixed-dose combination therapy will help demonstrate whether short-term changes in risk factors might be maintained and lead to expected differences in clinical events based on these changes
BACKGROUND Atherosclerotic cardiovascular disease ( ASCVD ) is the leading cause of death and disability worldwide , yet ASCVD risk factor control and secondary prevention rates remain low .
A fixed-dose combination of blood pressure- and cholesterol-lowering and antiplatelet treatments into a single pill , or polypill , has been proposed as one strategy to reduce the global burden of ASCVD .
OBJECTIVES To determine the effect of fixed-dose combination therapy on all-cause mortality , fatal and non-fatal ASCVD events , and adverse events .
We also sought to determine the effect of fixed-dose combination therapy on blood pressure , lipids , adherence , discontinuation rates , health-related quality of life , and costs .
Effects of renin-angiotensin blockers/inhibitors and statins on mortality and functional impairment in polypathological patients.
BACKGROUND Frail and polypathological patients ( PP ) are often undertreated with evidence -based cardiovascular drugs , as their benefits are uncertain in this population . OBJECTIVES To determine the effects of treatment with renin-angiotensin system blockers/inhibitors ( ACEI/ARB ) , statins and /or beta-blockers on survival rates and functional decline in PP with evidence -based clinical indications for treatment with any of these drug families . METHOD Prospect i ve observational multicentre cohort study with a 12-month follow-up period . We selected PP with any condition of the following : chronic heart failure , coronary heart disease , chronic renal disease , cerebrovascular disease , peripheral artery disease , diabetes mellitus with any visceral involvement , hypertension , and dyslipidaemia . Clinical , functional ( Barthel index ) , socio-familial risk data and drug prescriptions were measured at baseline . Multivariate Cox proportional hazards and logistic regression models were used to identify variables independently associated with survival and functional decline . RESULTS The analysis included 1260 PP . The mean age was 79±9.5 years . The mortality rate was 34.5 % . Statin ( aHR 0.671 ; P=0.001 ) , beta-blocker plus statin ( aHR 0.645 ; P=0.007 ) , ACEI/ARB plus statin ( aHR 0.680 ; P=0.002 ) , or combined ACEI/ARB plus statin plus beta-blocker ( aHR 0.541 ; P=0.000 ) prescriptions were associated with longer survival times . Additionally , PP whose Barthel index was ≥60 showed a lower risk of disability progression if treated with statins ( aOR=0.476 ; P=0.000 ) , or their combinations , mainly with ACEI/ARB plus beta-blockers ( aOR 0.563 ; P=0.031 ) . CONCLUSIONS The prescription of statins , alone or in combination with other drugs , may impact the survival and functional decline  in polypathological patients . Further prospect i ve blinded r and omised assays are needed to confirm these observations
The effects of fixed-dose combination therapy on all-cause mortality or ASCVD events are uncertain .
A limited number of trials reported these outcomes , and the included trials were primarily design ed to observe changes in ASCVD risk factor levels rather than clinical events , which may partially explain the observed differences in risk factors that were not translated into differences in clinical outcomes among the included trials .
Fixed-dose combination therapy is associated with modest increases in adverse events compared with placebo , active comparator , or usual care but may be associated with improved adherence to a multidrug regimen .
Ongoing , longer-term trials of fixed-dose combination therapy will help demonstrate whether short-term changes in risk factors might be maintained and lead to expected differences in clinical events based on these changes
BACKGROUND Atherosclerotic cardiovascular disease ( ASCVD ) is the leading cause of death and disability worldwide , yet ASCVD risk factor control and secondary prevention rates remain low .
A fixed-dose combination of blood pressure- and cholesterol-lowering and antiplatelet treatments into a single pill , or polypill , has been proposed as one strategy to reduce the global burden of ASCVD .
OBJECTIVES To determine the effect of fixed-dose combination therapy on all-cause mortality , fatal and non-fatal ASCVD events , and adverse events .
We also sought to determine the effect of fixed-dose combination therapy on blood pressure , lipids , adherence , discontinuation rates , health-related quality of life , and costs .