Reductions in blood pressure and lipid parameters are generally lower than those previously projected , though substantial heterogeneity of results exists .
Fixed-dose combination therapy is associated with modest increases in adverse events compared with placebo , single drug active component , or usual care but may be associated with improved adherence to a multidrug regimen .
BACKGROUND Cardiovascular disease ( CVD ) is the leading cause of death and disability worldwide , yet CVD 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 CVD by up to 80 % given its potential for better adherence and lower costs .
OBJECTIVES To determine the effectiveness of fixed-dose combination therapy on reducing fatal and non-fatal CVD events and on improving blood pressure and lipid CVD risk factors for both primary and secondary prevention of CVD .
We also aim ed to determine discontinuation rates , adverse events , health-related quality of life , and costs of fixed-dose combination therapy .
Laboratory-based versus non-laboratory-based method for assessment of cardiovascular disease risk: the NHANES I Follow-up Study cohort
BACKGROUND Around 80 % of all cardiovascular deaths occur in developing countries . Assessment of those patients at high risk is an important strategy for prevention . Since developing countries have limited re sources for prevention strategies that require laboratory testing , we assessed if a risk prediction method that did not require any laboratory tests could be as accurate as one requiring laboratory information . METHODS The National Health and Nutrition Examination Survey ( NHANES ) was a prospect i ve cohort study of 14 407 US participants aged between 25 - 74 years at the time they were first examined ( between 1971 and 1975 ) . Our follow-up study population included participants with complete information on these surveys who did not report a history of cardiovascular disease ( myocardial infa rct ion , heart failure , stroke , angina ) or cancer , yielding an analysis data set N=6186 . We compared how well either method could predict first-time fatal and non-fatal cardiovascular disease events in this cohort . For the laboratory-based model , which required blood testing , we used st and ard risk factors to assess risk of cardiovascular disease : age , systolic blood pressure , smoking status , total cholesterol , reported diabetes status , and current treatment for hypertension . For the non-laboratory-based model , we substituted body-mass index for cholesterol . FINDINGS In the cohort of 6186 , there were 1529 first-time cardiovascular events and 578 ( 38 % ) deaths due to cardiovascular disease over 21 years . In women , the laboratory-based model was useful for predicting events , with a c statistic of 0.829 . The c statistic of the non-laboratory-based model was 0.831 . In men , the results were similar ( 0.784 for the laboratory-based model and 0.783 for the non-laboratory-based model ) . Results were similar between the laboratory-based and non-laboratory-based models in both men and women when restricted to fatal events only . INTERPRETATION A method that uses non-laboratory-based risk factors predicted cardiovascular events as accurately as one that relied on laboratory-based values . This approach could simplify risk assessment in situations where laboratory testing is inconvenient or unavailable
Reductions in blood pressure and lipid parameters are generally lower than those previously projected , though substantial heterogeneity of results exists .
Fixed-dose combination therapy is associated with modest increases in adverse events compared with placebo , single drug active component , or usual care but may be associated with improved adherence to a multidrug regimen .
BACKGROUND Cardiovascular disease ( CVD ) is the leading cause of death and disability worldwide , yet CVD 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 CVD by up to 80 % given its potential for better adherence and lower costs .
OBJECTIVES To determine the effectiveness of fixed-dose combination therapy on reducing fatal and non-fatal CVD events and on improving blood pressure and lipid CVD risk factors for both primary and secondary prevention of CVD .
We also aim ed to determine discontinuation rates , adverse events , health-related quality of life , and costs of fixed-dose combination therapy .