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 .
The Effect of a Cardiovascular Polypill Strategy on Pill Burden.
AIMS Recent trials of cardiovascular polypills in high-risk population s show improvements in the use of cardiovascular preventive treatments , compared to usual care . We describe patterns of pill burden in Australian practice , define the impact of polypill therapy on pill burden , and explore how physicians add medication to polypill therapy . METHODS The Kanyini Guidelines Adherence with the Polypill Study was an open-label trial involving 623 participants in Australia which r and omized participants to a polypill strategy ( containing a statin , antiplatelet agent , and two blood-pressure-lowering medications ) or usual care . Participants either had established cardiovascular disease or were at high calculated risk ( ≥15 % over 5 years ) . Current medications , daily pill burden , and self-reported use of combination treatment were recorded prior to r and omization and at study end . Median pill burden at baseline and study end was compared in both arms . Subgroup analysis of the polypill strategy on trial primary outcomes was conducted by pill burden at baseline . RESULTS Median total and cardiovascular pill burdens of the polypill group decreased from 7 to 5 and from 4 to 2 , respectively ( median change -2 ; IQR -3 , 0 ) , with no change in the usual care group ( comparison of change ; P < 0.001 ) . No change was seen for noncardiovascular medications . Of those still using the polypill at study end , 43.8 % were prescribed additional medications ; 84.5 % of these additional medications were blood-pressure-lowering medications . Within the polypill group , lower pill burden at baseline was associated with greater increases in the use of indicated cardiovascular preventive medications at study end compared to those with higher pill burdens . No trend was observed between the level of baseline pill burden and the effect of poylpill treatment on systolic blood pressure or total cholesterol . CONCLUSION A cardiovascular polypill in contemporary Australian practice reduces cardiovascular and total pill burdens , despite frequent prescription of additional medications
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 .