Polypills with or without aspirin for primary prevention of cardiovascular disease

Abstract

Ischaemic heart disease and stroke are the conditions that contribute most to the global burden of disease, as measured by disability-adjusted life-years in people aged 50 years and older, 1 GBD 2019 Diseases and Injuries CollaboratorsGlobal burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396: 1204-1222 Summary Full Text Full Text PDF PubMed Scopus (978) Google Scholar despite many cardiovascular diseases being preventable. 2 O'Donnell MJ Chin SL Rangarajan S et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016; 388: 761-775 Summary Full Text Full Text PDF PubMed Scopus (781) Google Scholar , 3 Yusuf S Hawken S Ounpuu S et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364: 937-952 Summary Full Text Full Text PDF PubMed Scopus (7853) Google Scholar Two of the key modifiable risk factors are hypertension and high serum lipid concentrations. 2 O'Donnell MJ Chin SL Rangarajan S et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016; 388: 761-775 Summary Full Text Full Text PDF PubMed Scopus (781) Google Scholar , 3 Yusuf S Hawken S Ounpuu S et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364: 937-952 Summary Full Text Full Text PDF PubMed Scopus (7853) Google Scholar There is great interest in simple approaches with wide applicability to address these risk factors, including using fixed-dose combination drug regimens, also known as polypills. This strategy was proposed in the early 2000s and was predicted by one proponent to reduce cardiovascular disease by more than 80%. 4 Wald NJ Law MR A strategy to reduce cardiovascular disease by more than 80%. BMJ. 2003; 3261419 Crossref PubMed Google Scholar Although this original claim now seems overstated, evidence is accumulating from randomised controlled trials that polypills can reduce cardiovascular disease, but questions remain with regards to the balance of benefit and harm, the appropriate target population, and which drugs should be included in a polypill. Fixed-dose combination therapies with and without aspirin for primary prevention of cardiovascular disease: an individual participant data meta-analysisFixed-dose combination treatment strategies substantially reduce cardiovascular disease, myocardial infarction, stroke, revascularisation, and cardiovascular death in primary cardiovascular disease prevention. These benefits are consistent irrespective of cardiometabolic risk factors. Full-Text PDF