Polypill as a Strategy for Primary and Secondary Cardiovascular Prevention

Trial References
1. Muñoz D, Uzoije P, Reynolds C et al Polypill for cardiovascular disease prevention in an underserved population New Engl,. Med. 2019; 381;12:1114-1123
2. Rashandel G ,Khoshnia M, Poutchi H, et al. Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic,cluster-randomized trial.- Lancet 2019; 394:672-683
Expert Comment


Edgardo Escobar, Universidad de Chile, Santiago

Polypill has been proposed as an efficient strategy for primary and secondary cardiovascular prevention.  It has been shown that  a  fixed dose combination  therapy improves adherence compared  to usual treatment.

There are two  recent interesting papers regarding the use of Polypill.

The first one1 is a study of the adherence and effects of a Polypill  (Atorvastatin 10mg, Amlodi pine 2,5mg losartan 25mg and hydrochlorothiazide 12,5mg)  prescribed  to 303 adults, 96% black, in an underserved population with an annual income below  $ 15000 US dollars. Adherence, based on pill counts was 86%.  Compared to usual care a decrease of a mean systolic pressure of  9 mmHg  versus  2mmHg and a decrease of LDL cholesterol  of 15mg/dl  versus 4 mg /dl,  with the Polypill was observed.  These results, if sustained would lead to a 25% relative reduction in the estimated cardiovascular risk as compared with those assigned to receive usual care, at a monthly cost of $26 US dollars.  In spite of some limitations these results confirm previous findings of a good adherence to Polypill and potential clinical impact, and they are particularly important since the trial involved a low income, minority population

The second paper2 is a trial in 6838 individuals, 40 to 75 years of age, half treated with a  non pharmacologic  approach and the other half adding to this a Polypill (Atorvastin 20mg, Enalapril 5 mg, hydrochlorothiazide 12,5mg and Aspirin 81mg; in a subgroup Enalapril was replaced by Valsartan 40mg). Adherence to the polypill was 80.5%. In the first group, 8.8%  had a major cardiovascular event (HR 0.61) without statistic difference between absence or presence of preexisting cardiovascular disease. With better adherence reduction of cardiovascular events was even better (HR 0.43) It was concluded that  a low cost polypill should be considered as strategy of prevention particularly in low and middle income countries