Polypill plus aspirin and polypill alone reduced the risk of cardiovascular disease

Reviewed by Emily Henderson, B.Sc.November 15, 2020

A single daily pill that combines blood pressure and cholesterol medications, along with the addition of a daily dose of aspirin, reduced cardiovascular disease events in people at risk for heart disease, according to recent research presented in a study today. late clinician. presentation at the American Heart Association scientific sessions 2020. The virtual conference, held from Friday 13 to Tuesday 17 November 2020, is an important global exchange of the latest scientific advances, research and updates of evidence-based clinical practice in cardiovascular science for healthcare around the world. The manuscript of this study is published simultaneously today in The New England Journal of Medicine.

The medicine tested in this study is a fixed-dose combination therapy (or a ‘polypill’) that combines blood pressure and cholesterol-lowering drugs. Researchers evaluated the effects of polypill on cardiovascular disease events – such as heart attack, stroke and cardiovascular death – when given alone or with aspirin, in patients considered to be at intermediate risk for cardiovascular disease. They also looked at the effects of aspirin alone.

The International Polycap Study (TIPS) -3 is a large, randomized, placebo-controlled study conducted in nine countries. The study included 5,700 people considered to be at intermediate risk of developing heart disease. The mean age of the participants was 64, and 47% were male.

Participants were randomly assigned to different interventions: 1) 75 mg per day of aspirin; 2) a polypill that combines blood pressure and cholesterol medications daily; 3) polypill and 75 mg of aspirin per day; or 4) Vitamin D 5,000 IU per day. Each intervention included a control group that received a matching placebo. The drugs in the polypill were atenolol 100 mg, ramipril 10 mg, hydrochlorothiazide 25 mg and simvastatin 40 mg.

During the nearly five-year follow-up period, participants were monitored for the first occurrence of a major cardiovascular event, such as non-fatal heart attack, non-fatal stroke, heart failure, reanimated cardiac arrest, or cardiovascular death.

Analysis of all patient groups found:

• the polypill alone reduced cardiovascular disease by 21%;
• aspirin alone reduced cardiovascular death, heart attack or stroke by 14%;
• and polypill plus aspirin reduced cardiovascular disease by 31%.

Aspirin should be prescribed with a polypill in primary prevention for patients at intermediate risk of heart disease. The results of our study provide important data on the role of the polypill in preventing the development of heart disease. “

Salim Yusuf, MD, BS, D. Phil., Study co-author and professor of medicine at McMaster University School of Medicine in Toronto, Canada

Co-author Prem Pais, MBBS, MD, professor in the division of clinical research and education at St. John’s Research Institute in Bangalore, India, added: “We were also interested in considering whether to combine blood pressure and blood pressure lowering drugs. cholesterol in a single pill would be effective for this population. It is a cost-effective strategy that could help achieve global CVD reduction targets by 30% by 2030. “

“Using a polypill plus aspirin can prevent 3-5 million cardiovascular deaths globally,” Yusuf said. “Future polypills, with newer statins, can reduce LDL cholesterol and blood pressure to a greater extent and could reduce the risk of cardiovascular disease by more than 50%.”