Polypill in cardiovascular disease prevention: recent advances

Abstract

Triple therapy with lipid lowering, antihypertensive, and antiplatelet agents reduce the risk of recurrent cardiovascular (CV) fatal and non-fatal events, CV mortality and total mortality in secondary prevention. In real life, however, effective implementation of these optimal treatments both in primary and secondary prevention is low and thus their contribution to CV prevention is much less than it could be, based on research data. One of the main barriers to the adequate implementation of this strategies is low adherence to such elevated number of pills, because adherence is adversely affected by the complexity of the prescribed treatment regimen and can be considerably improved by treatment simplification. This review will update the findings provided by recent epidemiological and clinical studies favouring a polypill-based approach to CV prevention. The elevated prevalence of subjects with multiple CV risk factors and comorbidities provides the rationale for a therapeutic strategy based on the combination in a single tablet of drugs against different risk factors. Pharmacological studies have demonstrated that different CV drugs can be combined in a single tablet with no loss of their individual efficacy and this favours both adherence and persistence in treatment and multiple risk factor control. Recently, the randomized clinical trial Secondary Prevention of Cardiovascular Disease in the Elderly (SECURE), has shown a significant 30% reduction in CV events and 33% reduction in CV death in patients after myocardial infarction treated with a polypill in comparison with usual care, supporting its use as an integral part of any CV prevention strategy.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

“…However, present data also document that the polypill reduces the risk of CV outcomes. This was initially reported by large observational studies in patients with established atherosclerotic CVD [656] and has more recently been proven by the results of large outcome-based RCTs in patients with and also without previous CV events [661,662]. In an individual-participant meta-analysis of three primary prevention trials, a combination of two antihypertensive agents and a statin at low doses reduced the risk of CV outcomes by 38%.…”

“…Bioequivalence studies suggest that, when combined in the polypill, different agents maintain their expected effect [660], including the BP-lowering efficacy. Furthermore, studies performed in the setting of secondary CV prevention, particularly in patients with a previous myocardial infarction, have shown that use of the polypill is accompanied by better adherence to treatment compared with separately administered medications [656]. This is true for treatment simplification in general.…”

“…11.10.7 The polypill concept Polypills consist of SPCs of one or two antihypertensive agents and a statin with or without low-dose acetyl salicylic acid (aspirin) [656]. Different doses of antihypertensive agents, usually including an ACEi, are available.…”

Optimizing drug adherence in hypertension: More than a mind game

“…Using a lipid-lowering combination pill [52] or even a so-called cardiovascular polypill (containing antihypertensives and lipid-lowering treatment with or without low-dose aspirin) has been shown to have a positive impact on both adherence and cardiovascular outcomes [53]. According to the context, the use of generic, low-cost poly-pills may help overcome socioeconomic barriers in cardiovascular prevention [54].…”

Redefining the polypill: pros and cons in cardiovascular precision medicine

“…The CVPs can be a cost-effective, feasible, and overall attractive option in the improvement of CV health than Frontiers in Pharmacology frontiersin.org targeting individual risk factors (Yusuf, 2002;Lim et al, 2007). In the long term, these can help in reducing the healthcare costs (Roebuck et al, 2011;Becerra et al, 2015;Coca et al, 2023). Based on a wide range of factors, the cost of polypill has been anticipated between $0.06-$0.94/day (Singh et al, 2018).…”