Low-Cost, Fixed-Dose Polypill Reduces Risk for Major CV Events

Use of a four-component polypill can effectively reduce the risk for major cardiovascular events, according to a study published in the issue of The Lancet.

Gholamreza Roshandel, Ph.D., from Shariati Hospital in Tehran, Iran, and colleagues assessed the effectiveness and safety of a four-component polypill, including aspirin, atorvastatin, hydrochlorothiazide, and enalapril or valsartan, for the prevention of cardiovascular disease in a cohort study including participants of the PolyIran study aged 40 to 75 years from the Golestan province, Iran. Villages were randomly assigned to a package of nonpharmacological preventive interventions either alone (3,417 individuals in 116 clusters) or with a once-daily polypill tablet (3,421 individuals in 120 clusters).

The researchers found that the median adherence to polypill tablets was 80.5 percent. Overall, 8.8 percent of participants in the minimal care group and 5.9 percent in the polypill group had major cardiovascular events during follow-up (adjusted hazard ratio [aHR], 0.66; 95 percent confidence interval [CI], 0.55 to 0.80). No significant interaction was noted with the presence (aHR, 0.61; 95 percent CI, 0.49 to 0.75) or absence of preexisting cardiovascular disease (aHR, 0.80; 95 percent CI, 0.51 to 1.12; Pinteraction = 0.19). The reduction in the risk for major cardiovascular events was even greater when restricted to participants in the polypill group with high adherence compared with the minimal care group (aHR, 0.43; 95 percent CI, 0.33 to 0.55).

"This pragmatic trial provides evidence that a polypill strategy could be considered as part of preventive programs to reduce cardiovascular disease burden among eligible adults, especially in low-income and middle-income countries," the authors write.

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