A pragmatic randomized trial of a polypill-based strategy to improve use of indicated preventive treatments in people at high cardiovascular disease risk

Autor: Anushka, Patel, Alan, Cass, David, Peiris, Tim, Usherwood, Alex, Brown, Stephen, Jan, Bruce, Neal, Graham S, Hillis, Natasha, Rafter, Andrew, Tonkin, Ruth, Webster, Laurent, Billot, Severine, Bompoint, Carol, Burch, Hugh, Burke, Noel, Hayman, Barbara, Molanus, Christopher M, Reid, Louise, Shiel, Samantha, Togni, Anthony, Rodgers
Rok vydání: 2014
Předmět:
Male
Simvastatin
Time Factors
Epidemiology
Sodium Chloride Symporter Inhibitors
General Practice
Administration
Oral
Angiotensin-Converting Enzyme Inhibitors
Blood Pressure
Disease
law.invention
Randomized controlled trial
Quality of life
Lisinopril
Risk Factors
law
Prospective Studies
Polypill
Framingham Risk Score
Polycap
Middle Aged
Adrenergic beta-1 Receptor Antagonists
Primary Prevention
Drug Combinations
Cholesterol
Hydrochlorothiazide
Treatment Outcome
Cardiovascular Diseases
Hypertension
Female
Cardiology and Cardiovascular Medicine
Tablets
medicine.drug
medicine.medical_specialty
Hyperlipidemias
medicine
Drugs
Generic
Humans
Rosuvastatin
Intensive care medicine
Antihypertensive Agents
Aged
Polypharmacy
Aspirin
business.industry
Australia
Atenolol
Hydroxymethylglutaryl-CoA Reductase Inhibitors
business
Biomarkers
Platelet Aggregation Inhibitors
Zdroj: European Journal of Preventive Cardiology. 22:920-930
ISSN: 2047-4881
2047-4873
DOI: 10.1177/2047487314530382
Popis: Most individuals at high cardiovascular disease (CVD) risk worldwide do not receive any or optimal preventive drugs. We aimed to determine whether fixed dose combinations of generic drugs ('polypills') would promote use of such medications.We conducted a randomized, open-label trial involving 623 participants from Australian general practices. Participants had established CVD or an estimated five-year CVD risk of ≥15%, with indications for antiplatelet, statin and ≥2 blood pressure lowering drugs ('combination treatment'). Participants randomized to the 'polypill-based strategy' received a polypill containing aspirin 75 mg, simvastatin 40 mg, lisinopril 10 mg and either atenolol 50 mg or hydrochlorothiazide 12.5 mg. Participants randomized to 'usual care' continued with separate medications and doses as prescribed by their doctor. Primary outcomes were self-reported combination treatment use, systolic blood pressure and total cholesterol.After a median of 18 months, the polypill-based strategy was associated with greater use of combination treatment (70% vs. 47%; relative risk 1.49, (95% confidence interval (CI) 1.30 to 1.72) p 0.0001; number needed to treat = 4.4 (3.3 to 6.6)) without differences in systolic blood pressure (-1.5 mmHg (95% CI -4.0 to 1.0) p = 0.24) or total cholesterol (0.08 mmol/l (95% CI -0.06 to 0.22) p = 0.26). At study end, 17% and 67% of participants in polypill and usual care groups, respectively, were taking atorvastatin or rosuvastatin.Provision of a polypill improved self-reported use of indicated preventive treatments. The lack of differences in blood pressure and cholesterol may reflect limited study power, although for cholesterol, improved statin use in the polypill group counter-balanced use of more potent statins with usual care.
Databáze: OpenAIRE
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