Polypill: Benefits Seen for Stroke and Other Outcomes

Abstract

A polypill-type strategy for primary prevention was first published at the turn of the century and advised that a multi-ingredient pill applied to an adult population would prevent up to 80% of cardiovascular and stroke events. Such a pill should contain small doses of antihypertensives, lipid-lowering drugs, and some nutrients. The startling increase of the global stroke burden has led to a revival of this concept and the propagation of a population-based prevention strategy. Recent cardiovascular fixed-dose combination trials have shown a significant effect in reducing not only blood pressure and cholesterol levels but also in reducing cardiovascular and stroke events. In most of the studies, the study population was for secondary prevention and the total number of strokes was small. Nevertheless, it is now clear that a large proportion of primary prevention must take this path. It is especially promising when combined with community health workers interventions for modifying risk behavior. While a polypill-type approach seems most efficacious in underserved regions of high-income countries as well as in low- and middle-income countries, it seems to have a large overall effect in spite of some problems with nonadherence or potential side effects. It should be available and affordable for large target populations. Larger phase 4 studies are under way.

Use of a Polypill to Reduce Cardiovascular Risk Factors in Primary and Secondary Prevention: Review and Use Guidelines

“…Thus, therapeutic adherence is a key factor to ensure the sustainability of the healthcare system since non-adherence is linked to worse health outcomes and higher costs for the system. [10][11][12] The creation of polypills involves the combination of different drugs without incompatibilities between them, safe, well tolerated, effective, recommended by clinical practice guidelines and physicochemically compatible with the rest of the components of the pill (excipients, etc.) .…”

“…14,15 According to its technical sheet, 16 the indication of the polypill containing AAS + Atorvastatin + Ramipril focuses on the secondary prevention of cardiovascular accidents as replacement treatment in adult patients adequately controlled with the three substances taken at the same time in equivalent doses, to reduce the risk of suffering a cardiovascular accident, when the patient has already suffered a previous cardiovascular event; at the moment the technical data sheet of this product does not include the primary prevention of cardiovascular accidents, despite the evidence in the sense of providing benefits. 11,17 The strategies using polypills for secondary cardiovascular prevention have shown greater comfort for the patient and an increase in treatment adherence up to 20%, 7,12,[17][18][19][20] improving not only cardiovascular risk factors but also decreasing CV events and the health expenditure derived from them, being considered a strategy of great cost-effectiveness. [20][21][22]…”

Pharmacological Prescription for Atrial Fibrillation, Dyslipidemia and Hypertension: Observational Analytical #TRIGERIA Study in Institutionalized Patients

“…Therapeutic adherence is a key factor in ensuring the sustainability of the healthcare system, as non-adherence is linked to poorer health outcomes and higher costs for the system. [11][12][13] The polymer containing in different doses Acetylsalicylic Acid (ASA) plus Ramipril and Atorvastatin has shown its clinical effectiveness and high tolerability. According to its technical sheet, the indication focuses on 14,1516 the secondary prevention of cardiovascular accidents as substitution treatment in adult patients adequately controlled with the three substances taken at the same time at equivalent doses to reduce the risk of suffering a CV accident when the patient has already suffered a previous event, not including the primary prevention of accidents CV, despite the evidence in the sense of providing benefits.…”

“…According to its technical sheet, the indication focuses on 14,1516 the secondary prevention of cardiovascular accidents as substitution treatment in adult patients adequately controlled with the three substances taken at the same time at equivalent doses to reduce the risk of suffering a CV accident when the patient has already suffered a previous event, not including the primary prevention of accidents CV, despite the evidence in the sense of providing benefits. 12,17 The strategies using polypills for secondary CV prevention have shown greater comfort for the patient and an increase in adherence to treatment up to 20%, improving not only the CVR factors 8,13,[17][18][19][20] but also reducing CV events and the health expenditure derived from them, being considered a strategy of great cost-effectiveness. [20][21][22] The change to a polypill with this composition has as advantages the increase in the use 13,18 of Antiplatelet Agents (AAP) and 1111 more favorably modify the levels of total cholesterol, LDL-cabbage, HDL-cabbage and 23 blood pressure, 1111 than in patients who follow treatment with 14 three separate drugs, especially in people with a history of nonadherence or who have some 24 Predictor of lack of pharmacological adherence, in patients who are not well controlled with equipotent doses and with adherence problems, in patients who are controlled with individual drugs, and in patients with comorbidities and polymedicated.…”

Adherence to treatment in patients with cerebrovascular disease as a multifactorial problem

“…Общий диапазон неприверженности составлял 7,0-83,5% [12]. Выявление факторов низкой приверженности должно быть направлено на разработку массовых и индивидуально адаптированных мероприятий, повышающих вероятность соблюдения врачебных рекомендаций и профилактики инсульта [13].…”