Abstract P329: The Use of Polypill Components is Related to Lower Vascular Morbidity Aand Mortality in Patients With Vascular Diseases or Type 2 Diabetes Mellitus
Authors: Lafeber Melvin , Graaf, van der Yolanda , Visseren Frank L , Grobbee Diederick E , Spiering Wilko 
Published: July 2021

Background and aims
Patients with established cardiovascular disease or diabetes mellitus type 2 (DM2) are likely to receive separate treatment of an aspirin, a statin and blood pressure (BP)-lowering agents. Combining these pharmacological agents into a cardiovascular polypill, could be considered in these patients to reduce prescription gaps and increase adherence. We evaluated the effect of the concomitant use of aspirin, a statin and BP-lowering agent(s) in patients with vascular diseases or DM2 on vascular morbidity and mortality in current clinical practice.

Methods
In total 5783 patients with coronary artery disease, cerebrovascular disease, abdominal aortic aneurysm, peripheral arterial occlusive disease or DM2 enrolled in the Second Manifestations of ARTerial disease study were followed/up for the occurerence of a subsequent vascular event (i.e. myocardial infarction (MI), ischaemic cerebrovascular accident (iCVA), vascular death), composite vascular endpoint (combination of previous mentioned) and all-cause mortality.

Results
In total 2456 (42%) used aspirin, a statin and 1 BP lowering agent. During a median of 5.3 years (interquartile range 2.7-9.3 years), 758 patients experienced a new vascular event and 737 died. Combination therapy with aspirin, statin and ≥1 BP lowering agent was associated with a lower risk of MI (HR 0.77; 95%CI 0.62-0.97), iCVA (HR 0.75; 95%CI 0.52-1.08), vascular mortality (HR 0.56; 95%CI 0.44-0.72), composite vascular endpoint (HR 0.52; 95%CI 0.43-0.63) and all-cause mortality (HR 0.52; 95%CI 0.43-0.63) after adjusting for confounding covariates (
Table 1
).

Table

Aspirin, statin and ≥1 BP lowering agents

Study endpoint

No. of events

HR (95%-CI)

Coronary Artery Disease

I
418
0,79 (0,63-0,97)

II

0,77 (0,62-0,95)

III

0,77 (0,62-0,95)

IV

0,79 (0,63-0,99)

PS

0,77 (0,62-0,97)

Cerebrovascular accident

I
181
0,65 (0,46-0,91)

II

0,64 (0,46-0,90)

III

0,65 (0,46-0,91)

IV

0,78 (0,54-1,13)

PS

0,75 (0,52-1,08)

Composite Vascular Endpoint

I
720
0,73 (0,62-0,86)

II

0,72 (0,61-0,85)

III

0,73 (0,61-0,86)

IV

0,78 (0,65-0,94)

PS

0,75 (0,62-0,89)

Vascular Mortality

I
428
0,59 (0,47-0,75)

II

0,62 (0,49-0,78)

III

0,60 (0,48-0,76)

IV

0,63 (0,49-0,80)

PS

0,56 (0,44-0,72)

All-cause Mortality

I
737
0,54 (0,45-0,65)

II

0,56 (0,47-0,67)

III

0,56 (0,47-0,68)

IV

0,57 (0,47-0,69)

PS

0,52 (0,43-0,63)

Model

I: Crude

II: Adjusted for gender, age

III: II + additional adjustment for BMI, current smoking, packyears, concommitent cardiovascular disease

IV: III + additional adjustment for LDL, systolic BP

Propensity Score: composed of gender, age, BMI, current smoking, packyears, concomitant cardiovascular disease, LDL cholesterol and systolic BP

Conclusion
The combined use of aspirin, statin and at least 1 BP lowering agent was associated with a lower risk of vascular morbidity and mortality in patients with established cardiovascular disease or DM2. Introduction of a polypill in these high risk patients may promote the use of preventive pharmacologic treatment and contribute to better adherence thereby decreasing the risk for vascular morbidity and mortality.