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A Polypill as Secondary Cardiovascular Prevention
The administration of multiple cardiovascular prevention medications with proven efficacy and low-adverse event rate in a single pill is called a polypill.
The concept of a polypill has been around for about 20 years and multiple polypill formulations have been studied.1-4 They all contain a low-dose, off-patent statin, at least one class of antihypertensive agent, and some contain low-dose aspirin.
When administered daily, the goal of a polypill is to reduce low density lipoprotein cholesterol or LDL-C and blood pressure in middle-aged to older adults at risk for cardiovascular disease. Benefits of this approach include wider coverage, adherence advantages, and lower costs.
Recent study results from the SECURE investigators4 who investigated polypill strategy were just published in the New England Journal of Medicine. The study population included patients who had suffered a myocardial infarction in the past 6 months and were assigned a polypill-based strategy or usual care. The polypill contained 100 mg of aspirin, 2.5, 5, or 10 mg of ramapril, and 20 mg or 40 mg of atorvastatin. The primary composite outcome was cardiovascular death, nonfatal type 1 myocardial infarction (characterized by coronary plaque rupture or erosion and superimposed thrombosis), nonfatal ischemic stroke, or urgent revascularization.
In 2499 patients randomized to polypill or usual care, the primary composite event occurred in 9.5% in the polypill group vs 15% in the usual care group (HR) 0.76 (CI: 0.60-0.96). Medication adherence reported by patient history was higher in the polypill group.
This data supports the use of a polypill for secondary cardiovascular prevention after a myocardial infarction. Pharmacists should recognize the benefits of simplifying treatment and improving adherence. The use of this type of treatment may have exciting potential for countries with under-resourced populations.
References:
- Bahiru E, de Cates AN, Farr MR, et al. Fixed-dose combination therapy for the prevention of atherosclerotic cardiovascular disease. Cochrane Database Syst Rev. 2017;3:CD009868. doi:10.1002/14651858.CD009868.pub3
- Roshandel G, Khoshnia M, Poutschi H, et al. Effectiveness of polypill for primary and secondary prevention of cardiovascular disease (PolyIran). Lancet 2019;394(10199):672-83. doi:10.1016/S0140-6736(19)31791-X
- Muňoz D, Uzoije P, Renolds C, et al. Polypill for cardiovascular disease prevention in an underserved population. N Engl J Med. 2019;381(12):1114-1123. doi: 10.1056/NEJMoa1815359
- Castellano JM, Pocock SJ, Bhatt DL, et al for the SECURE Investigators. Polypill strategy in secondary cardiovascular prevention. NEJM 2022 Published online August 26, 2022. doi:10.1056/NEJMam2208275
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