Use Of Polypill Research Articles

Polypills in the Management of Cardiovascular Risk-A Perspective.

Cardiovascular disease and cardiovascular risk factors are global healthcare problems, given their high prevalence and the recognized low rates of adequate control despite the abundant body of evidence on different therapeutic options. The World Heart Federation has scrutinized the reasons for poor control of cardiovascular risk factors. Among these reasons, patients' poor adherence to treatment regimens as well as limited rates of evidence-based therapy prescription from healthcare providers play a substantial role in the challenge of cardiovascular risk management. Polypills are fixed-dose combinations including two or more active drugs, from different pharmacological classes, combined in a single dosage form. Polypills were designed to simplify the clinical management of pharmacotherapy and increase adherence to treatment. From this perspective, we discuss the current literature on the use of polypills in the primary and secondary prevention of cardiovascular disease as well as future challenges and the potentials of this treatment strategy.

Polypill versus medication monotherapy in the prevention of cardiovascular diseases in Iran: An economic evaluation study.

Cardiovascular diseases (CVDs) are one of the major diseases in developing and developed countries and have high prevalence and mortality rates. Pharmacological interventions, especially the use of combination medications, can have preventive effects in patients with CVDs. Recently, in the PolyIran trial, a combination of atorvastatin, hydrochlorothiazide, aspirin, and valsartan or enalapril (Polypill) was shown to be effective in providing survival benefits as a primary prevention strategy. In the present study, we examine the cost-effectiveness of the use of polypill compared to its individual components (named as medication monotherapy) in the prevention of CVDs in Iran. This was an economic evaluation study conducted to compare the cost-utility of polypill with that of medication monotherapy for 10,000 hypothetical cohorts of people over 35 years of age using the Markov model and with a lifetime horizon. The study perspective was patient perspective and direct medical costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio were estimated. To deal with uncertaintysensitivity analyses were used. The results showed that polypill, with the lowest costs (871 USD) and highest QALYs (14.55), had the most cost-utility than medication monotherapy. Also, the results showed that the highest sensitivities were related to the utilities of angina and stroke states. At the 21,768 USD threshold, polypill had a 92% probability of being cost-effective versus other medications. Considering that polypill had the most cost-utility, it is suggested that health system policymakers pay special attention to polypill in designing clinical guidelines. Also, through covering this medication by health insurance organizations, it is possible to complete the country's medicine pharmacopeia in preventing CVDs.

ARE THERE ANY ADVANTAGES TO USING A POLYPILL OR FREE PILL COMBINATION TO PROTECT PATIENTS WITH ARTERIAL HYPERTENSION AND DYSLIPIDEMIA?

Objective: Arterial hypertension (AH) has been acknowledged as a leading cause of death. Treating AH alone may provide only limited benefits while it is recommendable to manage the total cardiovascular risk. The aim was to assess the treatment of AH and dyslipidemia (DLP) in patients in specialists’ offices. Design and method: This project was conducted from April to June 2023 in 51 specialists’ offices (SPO) (33% cardiology, and 67% internal medicine) in Slovakia. We have enrolled all 18-year-old pts who are willing to complete a short questionnaire and take office BP. Results: We enrolled 514 pts with AH (42% women), mean age 61,5 ± 17,2 years from SPOs. The mean OBP was 134,9 ± 10,9/ 80,3 ± 7,2 mmHg. The average total cholesterol (TC) was 5,7 mmol/l, LDL-C 3,0 mmol/l. TC (6,12 vs 5,15 mmol/l, p<0,01) was higher in male patients, and LDL-C was higher in female patients (3,05 vs 2,91 mmol/l). 76% pts experienced both AH and DLP simultaneously. In comparison to those without HLP, AH patients with HLP were given 0.5 active substances and 0.8 pills more. In total 79% pts with AH and HLP were treated with a free pill combination with a statin, while only 16% were treated with polypill. The use of polypill was more frequent in female pts (18%) vs male pts (14%). Target BP lower than 140/90 mmHg was reached in 68% pts with polypill, and in 53% pts without polypill. Non-HDL- C was lower in pts with polypill (3,6 vs 4,03 mmol/l). The current BP and non-HDL targets were reached more frequently in pts with polypill 56% vs 44% pts. Conclusions: Adherence to medications is important to achieve the full effect of antihypertensive and lipid-lowering drugs. We demonstrated that the use of polypill compared to a free pill combination of statin and AH therapy is more effective. 27% of patients reached BP and LDL targets when were treated by polypill. Using polypill in our pts we aim to reach a higher rate of BP and cholesterol control in Slovakia to meet the objectives of the Charter 70/2023 initiative.

A Meta-analysis of the Use of Polypill for Secondary Prevention of Atherosclerotic Cardiovascular Disease.

A Meta-analysis of the Use of Polypill for Secondary Prevention of Atherosclerotic Cardiovascular Disease.

Advancements in Antidiabetic Therapy: An extensive study on the use of Polypills to treat type 2 diabetes

The hallmark of type 2 diabetes (T2DM) is elevated blood glucose levels brought on by insulin resistance or inadequate insulin synthesis. Oral hypoglycaemic medications and insulin therapy are two examples of pharmacological therapies used in conjunction with lifestyle changes like diet and exercise to manage type 2 diabetes. However, because T2DM is a complex disease and requires many drugs to regulate different risk factors, managing the condition can be difficult. Polypills, or cardiovascular fixed-dose combination pills, have the potential to alleviate the pervasive inaccessibility and noncompliance with established medications. Switching from existing individually taken drugs is usually required to begin polypill-based therapy. The impact of polypill treatment across various patterns of previous pharmaceutical regimen is of relevance due to the heterogeneity in usual care. Utilizing a polypill helps streamline drug schedules, lessening patients' burden with pills, and possibly increasing adherence. In type 2 diabetes, when controlling blood pressure, cholesterol, and blood glucose levels frequently necessitates the use of many drugs, this is especially crucial. Recommendations state that those with established cardiovascular disease are probably now receiving aspirin, a statin, and blood pressure (BP)-lowering drugs. It might be reasonable to combine these medications into a cardiovascular polypill for these patients in order to reduce prescription gaps and non-adherence. A sizable portion of individuals suffering from long-term cardiovascular conditions currently use a combination of prescription drugs. Introduce a polypill to high-risk patients to reduce prescription gaps and enhance adherence to recommended therapy

Use of polypill to improve therapeutic adherence and outcomes in adults with recent acute myocardial infarction: is it an effective strategy?

Use of polypill to improve therapeutic adherence and outcomes in adults with recent acute myocardial infarction: is it an effective strategy?

The Effectiveness of Polypill for the Prevention of Cardiovascular Disease: A Meta-Analysis of Randomized Controlled Trials.

A significant global health concern, cardiovascular disease (CVD) is characterized by a rising prevalence and accompanying mortality rates. It is crucial to implement primary and secondary prevention strategies, particularly in resource-scarce settings. Polypills, which combine blood pressure, cholesterol, and homocysteine drugs, hold significant potential for lowering the risk of CVD. This study follows PRISMA meta-analysis guidelines. Two researchers conducted an extensive literature search. Inclusion criteria encompassed RCT design, polypill use, a four-week duration, and one meta-analysis outcome. Primary outcomes included MACE and CV mortality, while secondary outcomes encompassed SBP and LDL-C changes. Data extraction was performed independently, and conflicts were resolved. Review Manager 5.4 with random effects was employed for statistical analysis, and ROB 2.0 bias evaluation was conducted. The study reported CVD mortality and MACE risk ratios (RRs) with 95% CIs, as well as SBP and LDL-C weighted mean differences (MD). A total of 24 trials were included in this meta-analysis. The results revealed that the polypill was associated with a decreased risk of CVD mortality and major adverse cardiovascular events (MACE). Additionally, a significant reduction in systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C) was observed. This meta-analysis showed that polypill is a viable medication for reducing the risk of CVD mortality and MACE. It is also a beneficial medication for lowering LDL-C levels and SBP.

Examining the Use of a Polypill in Cardiovascular Disease Prevention.

Cardiovascular disease (CVD) is a significant cause of death worldwide. To address the global burden of CVD and its risk factors, the polypill, an all-in-one therapy that combines multiple existing medications for preventing CVD and reducing CVD events (such as angiotensin-converting enzyme inhibitor, beta-blocker, statin, or aspirin) into a single combination pill, has emerged as a potential strategy to improve CVD prevention. Clinical trials on the polypill have found that polypill use is associated with significant reductions in CVD events and risk factors in both patients with established CVD and at risk of developing CVD, suggesting a potential benefit in primary and secondary CVD prevention. The polypill has also been demonstrated to be a cost-effective therapy that may potentially increase treatment accessibility, affordability, and availability particularly in low- and middle-income countries. Further, patients on polypill therapy have shown high rates of treatment compliance, with significant improvements in medication adherence for patients with low baseline compliance. Given its potential advantages and benefits, the polypill may become a promising therapy for the prevention of CVD.

Meta-Analysis on the Clinical Outcomes With Polypills for Cardiovascular Disease Prevention

Randomized controlled trials (RCTs) examining the outcomes of "polypill" therapy in cardiovascular disease prevention have yielded mixed results. We performed an electronic search through January 2023 for RCTs that examined the use of polypills for cardiovascular disease primary or secondary prevention. The primary outcome was the incidence of major adverse cardiac and cerebrovascular events (MACCEs). The final analysis included 11 RCTs with 25,389 patients; 12,791 patients were in the polypill arm, and 12,598 patients were in the control arm. The follow-up period ranged from 1 to 5.6 years. Polypill therapy was associated with a lower risk of MACCE (5.8% vs 7.7%; risk ratio [RR] 0.78, 95% confidence interval [CI] 0.67 to 0.91). The reduction of MACCE risk was consistent in both primary and secondary prevention. Polypill therapy was associated with a lower incidence of cardiovascular mortality (2.1% vs 3%; RR 0.69, 95% CI 0.55 to 0.87), myocardial infarction (2.3% vs 3.2%; RR 0.72, 95% CI 0.61 to 0.84) and stroke (0.9% vs 1.6%; RR 0.62, 95% CI 0.42 to 0.90). Polypill therapy was associated with a higher degree of adherence. There was no difference between both groups in the incidence of serious adverse events (16.1% vs 15.9%; RR 1.12, 95% CI 0.93 to 1.36). In conclusion, we found that a polypill strategy was associated with a lower incidence of cardiac events and higher adherence, without an increased incidence of adverse events. This benefit was consistent for both primary and secondary prevention.

Polypill in cardiovascular disease prevention: recent advances.

Triple therapy with lipid‑lowering, antihypertensive, and antiplatelet agents reduces the risk of recurrent cardiovascular fatal and nonfatal events, cardiovascular 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 cardiovascular prevention is much lower than it could be, based on research data. One of the main barriers to the adequate implementation of these strategies is low adherence to the elevated number of pills, as adherence is adversely affected by the complexity of the prescribed treatment regimen, and can be considerably improved by treatment simplification. This review updates the findings provided by recent epidemiological and clinical studies favoring a polypill‑based approach to cardiovascular prevention. The increased prevalence of patients with multiple cardiovascular risk factors and comorbidities provides the rationale for a therapeutic strategy based on a combination of drugs against different risk factors in a single pill. Pharmacologic studies have demonstrated that different cardiovascular drugs can be combined in a single pill with no loss of their individual efficacy, and this favors adherence to and persistence of treatment, as well as multiple risk factor control. Recently, a randomized clinical trial SECURE (Secondary Prevention of Cardiovascular Disease in the Elderly) has shown a significant, 30% reduction in cardiovascular events, and a 33% reduction in cardiovascular death in patients after myocardial infarction treated with a polypill, as compared with usual care, thus supporting the polypill use as an integral part of any cardiovascular prevention strategy.

Polypharmacy in cardiorenal syndrome patients.

Cardiorenal syndrome (CRS) is a term defined as complex interactions between concomitant cardiac and renal dysfunction in which disease of one organ initiates, perpetuates, and/or accelerates the decline in the other. It accounts for a third of presentations with heart failure and is associated with poor clinical outcomes. Polypharmacy (defined as using five or more medications) is common in CRS patients and is associated with worst clinical outcomes. The risk for polypharmacy increases to several fold with associated comorbidities, poses risks to the overall health of the patient, and enhances non-compliance to essential medications. Deprescribing non-essential medications, coordination between multiple specialties to mitigate the risk of polypharmacy, pharmacist- and nurse-led clinics to improve adherence to medications, use of polypills and telemonitoring are various methods to reduce polypharmacy. In this paper, we highlight different strategies to prevent polypharmacy and improve compliance and adherence to essential medications.

PS-BPC12-2: EFFICACY AND SAFETY OF SINGLE-PILL COMBINATION OF OLOMAXÂ (OLMESARTAN, AMLODIPINE, AND ROSUVASTATIN) IN HYPERTENSIVE PATIENTS WITH LOW-TO-MODERATE CARDIOVASCULAR RISK

Objective: Of the ten hypertensive patients who have to take statins in Korea, about two are not actually prescribed. The use of polypills including lipid-lowering and blood pressure (BP)-lowering drug improves medication adherence, and consequently ameliorates in cardiovascular risk levels. This study was to evaluate the efficacy and safety of single-pill triple-combination of olmesartan/amlodipine/rosuvastatin (OLOMAX®) in comparison to single-pill dual-combination of olmesartan/amlodipine (SEVIKAR®) in hypertensive patients with low-to-moderate cardiovascular risk. Design and method: This multicenter, active-control, randomized study included 106 hypertensive patients with low-to-intermediate cardiovascular risk, who were randomly assigned to receive either OLOMAX®(20/5/5 mg, treatment 1), OLOMAX®(20/5/10 mg, treatment 2), or SEVIKAR®(20/5 mg, control) once daily for 8 weeks. The low and moderate cardiovascular risk groups were defined according to the definition of the 4th Korean dyslipidemia treatment guidelines. Primary endpoint was assessed as the difference of the percent change of LDL-C(low-density lipoprotein-cholesterol) level at 8 weeks from baseline among the three groups. Results: The difference in the least square mean % change of LDL-C in the treatment 1 and 2 groups compared to the control group at 8 weeks was -32.6 ± 3.7% and -45.9 ± 3.3%, respectively (all p < 0.001). There was significant difference in the achievement rate of LDL-C levels < 100 mg/dL at 8 weeks between the three groups (65.8% for the treatment 1 group, 86.7% for the treatment 2 group, and 6.25% for the control group, p < 0.001). The results of total cholesterol, triglycerides, high-density lipoprotein-cholesterol, apolipoprotein B, and apolipoprotein B/apolipoprotein A1 showed the superiority in the treatment 1 and 2 groups compared to the control group. Meanwhile, there was no significant difference in systolic and diastolic BPs and diabetes-related variables including fasting glucose, fructosamine, and hemoglobinA1c at 8 weeks between the three groups. Adverse drug reaction (ADR) developed only 1 case (constipation) in the treatment 1 group and serious ADR did not occur in the three groups. Medication adherence rates were highly excellent in the three groups (98.0% for the treatment 1 group, 99.7% for the treatment 2 group, and 96.3% for the control group, p > 0.05). Conclusions: Single-pill triple-combination of olmesartan/amlodipine/rosuvastatin were superior to single-pill dual-combination of olmesartan/amlodipine in LDL-C lowering effect, with similar BP reduction effects and excellent safety profiles in hypertensive patients with low to moderate cardiovascular risk.

National Trends in Statin Use in Lithuania from 2010 to 2021.

Objective: In Lithuania, no comprehensive national research on statin utilization and trends has yet been undertaken. Nonetheless, this knowledge is critical for the healthcare system to identify key areas for development. We aimed to analyze trends in statin utilization in Lithuania from the past 12 years considering changes in reimbursement policies and the publication of updated international CVD prevention guidelines. Methods: We performed a retrospective, descriptive study of statin utilization in Lithuania from 2010 to 2021. The data were obtained from PharmaZOOM LT, an independent software supplier with nationwide coverage on pharmaceutical market data. The data coverage was 95%. We used anatomical therapeutic chemical (ATC) classification for data extraction and calculated defined daily doses (DDDs) according to the ATC/DDD Toolkit of World Health Organization according to statin dose in a pill. Results: Statin use increased overall from 8.28 DDD/TID in 2010 to 96.06 DDD/TID in 2021. The annual growth rate in sales of statin DDD/TID was 22.28%. The increase was mostly due to the increase in moderate- and high-intensity statins. The increases coincided with changes in reimbursement policy or the publication of international guidelines. Polypill use in Lithuania began steadily increasing after 2016 and reached 19.37% of the total DDD/TID of statins in 2021. Conclusions: The use of statins has increased dramatically in Lithuania over the last decade. Changes in statin reimbursement regulations in the country, as well as worldwide cardiovascular preventive recommendations aiming at lower LDL-C objectives, fueled the progress.

Acute, periprocedural and longterm antithrombotic therapy in older adults: 2022 Update by the ESC Working Group on Thrombosis

The first international guidance on antithrombotic therapy in the elderly came from the European Society of Cardiology Working Group on Thrombosis in 2015. This same group has updated its previous report on antiplatelet and anticoagulant drugs for older patients with acute or chronic coronary syndromes, atrial fibrillation, or undergoing surgery or procedures typical of the elderly (transcatheter aortic valve implantation and left atrial appendage closure). The aim is to provide a succinct but comprehensive tool for readers to understand the bases of antithrombotic therapy in older patients, despite the complexities of comorbidities, comedications and uncertain ischaemic- vs. bleeding-risk balance. Fourteen updated consensus statements integrate recent trial data and other evidence, with a focus on high bleeding risk. Guideline recommendations, when present, are highlighted, as well as gaps in evidence. Key consensus points include efforts to improve medical adherence through deprescribing and polypill use; adoption of universal risk definitions for bleeding, myocardial infarction, stroke and cause-specific death; multiple bleeding-avoidance strategies, ranging from gastroprotection with aspirin use to selection of antithrombotic-drug composition, dosing and duration tailored to multiple variables (setting, history, overall risk, age, weight, renal function, comedications, procedures) that need special consideration when managing older adults.

NEPTUNO: polypill Trinomia. Pharmacoeconomic benefit

The article presents an overview of NEPTUNO’s own survey and research on the pharmacoeconomic analysis of the use of the polypill strategy.
 In the NEPTUNO study, it was shown that the use of a cardiovascular polypill containing acetylsalicylic acid, ramipril, atorvastatin (CNIC-Polypill – Trinomy) resulted in significantly lower use of health care resources compared to control groups; significantly lower total and direct medical costs. And this, in turn, led to a decrease in hospitalizations, cardiovascular events and the number of visits to the doctor.

Association of polypill therapy with cardiovascular outcomes, mortality, and adherence: A systematic review and meta-analysis of randomized controlled trials

Prior studies have reported improvements in population-level risk factor burden and cardiovascular disease (CVD) outcomes using polypills for CVD risk reduction. However, a comprehensive assessment of the impact of polypills on CVD outcomes, mortality, adherence, and side effects across different settings has not previously been reported. We performed a systematic review and meta-analysis of randomized controlled trials examining the association between polypill therapy and CVD outcomes published before February 2021. The primary outcome of interest was the risk of major adverse CVD events (MACE). Risk ratios for dichotomous outcomes were converted to log RR and pooled using a generic inverse variance weighted random-effects model. Data for continuous outcomes were pooled using random-effects modeling and presented as mean differences with 95% CIs. Eight studies representing 25,584 patients were included for analysis. In the overall pooled analysis, the use of polypills was associated with a non-significant reduction in the risk of MACE (RR: 0.85; 95% CI: 0.70–1.02) and significant reductions in the risk of all-cause mortality (RR: 0.90; 95% CI: 0.81–1.00). The reductions in the risk of MACE with polypill use varied by baseline risk and nature of the study population (primary prevention vs. secondary prevention), with the most significant risk reduction among lower-risk cohorts, including within primary prevention populations [RR 0.70 (0.62, 0.79)]. Among measures of CVD risk factors, modest but significant reductions were observed for systolic and diastolic blood pressure [systolic: mean difference 1.99 mmHg (95% CI: −3.07 to −0.91); diastolic: mean difference 1.30 mmHg (95% CI: −2.42 to −0.19), but not for levels of total or low-density lipoprotein-cholesterol. Use of the polypill strategy significantly improved drug adherence (RR: 1.31; 95% CI: 1.11–1.55) with no association between polypill use and rates of adverse events or drug discontinuation. The use of polypill formulations is associated with significant reductions in CVD risk factors and the risk of all-cause mortality and MACE, particularly in the low-risk and primary prevention population.

Abstract 14379: Polypill Therapy and Risk of Adverse Cardiovascular Events and Mortality: A Systematic Review and Meta-Analysis

Introduction: Prior studies have reported improvements in population-level risk factor burden and cardiovascular outcomes using polypill strategy. We aimed to provide an updated meta-analysis of RCTs evaluating the efficacy of polypill-based strategy in reducing the risk of adverse cardiovascular outcomes. Methods: RCTs examining the association between polypill therapy and cardiovascular outcomes published before 2/1/2021 were included. The outcomes of interest were major adverse cardiovascular events (MACE) and all-cause mortality. Risk ratios for dichotomous outcomes were converted to log RR and pooled using a generic inverse variance weighted random-effects model. Data for continuous outcomes were pooled using random-effects modeling and presented as mean differences with 95% CIs. Results: Eight studies representing 25,584 patients were included for analysis. In pooled analysis, the use of polypills was associated with a non-significant reduction in the risk of MACE [RR(95% CI): 0.85(0.70-1.02)] and significant reductions in the risk of all-cause mortality [RR(95% CI): 0.90(0.81-1.00)]. The reductions in the risk of MACE with polypill use varied by baseline risk and nature of the study population [primary prevention (polypill, 476/10503; control, 684/10509) vs. secondary prevention (polypill, 170/2307; control, 153/2265)], with the most significant risk reduction among lower-risk cohorts, including within primary prevention populations [RR 0.70 (0.62, 0.79)]. Among CV risk factors, modest but significant reductions were observed for systolic and diastolic blood pressure, but not for levels of total or LDL-cholesterol. Polypill strategy was also associated with significantly improved drug adherence [RR(95% CI): 1.31(1.11-1.55)]. Conclusions: . Polypill strategy is associated with significant reductions in cardiovascular risk factors and the risk of all-cause mortality and MACE, particularly in the primary prevention population.

Abstract 9893: Polypills for Primary Prevention of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Clinical Trials

Background: Single pills with fixed-dose combinations (FDC) of lipid and blood pressure lowering medications have been proposed for the treatment of cardiovascular disease. Although polypills have proven to be effective in secondary prevention of major cardiovascular events, there is a lack of evidence regarding polypill use in primary prevention in intermediate and high-risk patients. This systematic review and meta-analysis was conducted to evaluate the effect of polypills on primary prevention of cardiovascular (CV) events using data from clinical trials. Methods: We searched Pubmed, Web of Science, EBSCO, and SCOPUS through May 2021. Two authors independently screened articles for fulfillment of inclusion criteria. The RevMan (version 5.4) software was used to calculate the pooled risk ratios (RRs) and mean differences (MDs), along with their associated confidence intervals (95% CI). Results: Eight trials with a total of 20653 patients were included. There was a significant reduction in total fatal and non-fatal CV events among the polypill group [RR (95% CI) = 0.71 (0.63, 0.80); P < 0.001]. Moreover, this reduction was present for both the intermediate [RR (95% CI) = 0.76 (0.65, 0.89); P < 0.001] and high-risk [RR (95% CI) = 0.63 (0.52, 0.76); P < 0.001] group of patients. Subgroup analysis based on the follow up duration revealed this benefit was only evident in the five-year follow up duration group [RR (95% CI) = 0.70 (0.62, 0.79); P< 0.001] and was absent in the one-year or less interval group [RR (95% CI) = 0.77 (0.47, 1.29); P= 0.330]. Furthermore, there was a significant reduction in 10-year predicted cardiovascular risk in the polypill group [MD (95% CI) = -3.74 (-5.96, -1.51); P< 0.001] compared to controls. Conclusion: A polypill strategy decreases the incidence of fatal and non-fatal CV events in patients with intermediate and high cardiovascular risk and may be an effective component in the care of these patients.

Generating and implementing new concepts on a population level

Stroke is one of the leading causes of death and disability worldwide. There is a decline in stroke incidence and death in high income countries (HICs) however in low to middle income countries there is an increase incidence of stroke. Ninety percent of the risk factors of stroke are preventable. Hypertension, diabetes, dyslipidemia, smoking, alcohol intake, atrial fibrillation, obesity are some of the important risk factors for stroke. Prevention can be divided into primordial, primary and secondary. At the population level high risk individuals can be screened and interventions can be implemented. There is evidence in the use of mHealth, decision supporting system and task shifting to community health workers from LMICs in the prevention of stroke. Stroke riskometer and few other Mobile Apps can be used to identify people at risk of developing stroke. There is also evidence for the use of polypill and control of risk factors using health care workers in the villages to prevent cardiovascular diseases and stroke.

Polypills in Cardiovascular Disease Prevention: Mass-Strategy Approach, Precision Medicine, or an Essential Intertwine Between Them?

This review considers the framework of high-risk vs. population approaches as proposed in the Rose's axiom within the context of cardiovascular diseases, including its benefits and limitations. We also contextualize the use of precision medicine in primary prevention therapy and contrast that with population approach. Although the high-risk strategy aims at individualized care, the complexity of pharmacologic regimens and other limitations reduces its real-life impact. On the other hand, broad population strategies include treatment of a substantial number of low-risk individuals who are unlikely to benefit from treatment. The use of additional strategies to identify those low-risk individuals, instead of targeting at identifying the high-risk population, is and alternative strategy to be considered. Evidence of the potential use of coronary artery calcium score and polypills for this strategy is discussed. A more targeted population approach to primary prevention in cardiovascular diseases with the use of polypills and coronary artery calcium score might be considered in a structured mass-strategy approach to risk reduction.