title: Requirement of pharmacological treatment for primary prevention of cardiovascular disease in asymptomatic office-executives in north-India.
abstract: BACKGROUND
  Recently, a concept of multi-drug treatment of all individuals in the form of a polypill, irrespective of their risk factor profile, has been proposed with a view to provide an effective means for prevention of cardiovascular disease (CVD). While the rationale, benefits and ethicality of such an approach continue to remain a matter ofdebate, it is not known what proportion of asymptomatic adult population does actually require pharmacological therapy for primary prevention of CVD according to the existing guidelines.
  
  
  METHODS
  1927 consecutive office executives, free of any CVD, undergoing routine health check-up at a tertiary care centre in North-India during the year 2005 were included in the study. For all subjects, information was collected based on their case-records comprising of comprehensive clinical evaluation and the results of biochemical investigations. Requirement of treatment with three anti-atherosclerotic drugs- aspirin, statin and an anti-hypertensive agent was estimated as per the current guidelines.
  
  
  RESULTS
  Mean age of the subjects was 45.2 +/- 10.3 years and 71.6% were males. Diabetes was present in 14.3%, hypertension in 46.3% and dyslipidemia in 76.0%. Metabolic syndrome was diagnosed in 47.5% subjects. According to the currently accepted guidelines, 47.0% of all the individuals were candidates for at least one of the three aforementioned drugs--22.9% needed only one drug, 17.8% needed only two drugs and 6.3% needed all the three drugs. Requirement of the treatment was much higher in the highest age-tertile (>50 years of age) with 78.0% needing at least one medication, 45.1% needing at least two medications and 12.6% needing all the three drugs (p value < 0.001). Of the different drugs, aspirin was the most commonly required medicine (38.3% of all) and a combination of aspirin and statin was the most commonly required two-drug combination.
  
  
  CONCLUSIONS
  The present study shows that, in spite of high prevalence of CV risk factors, a majority of office-executives who are free of CVD do not require multi-drug therapy for primary prevention of CVD as per the current recommendations. Though a greater proportion of the individuals > 50 years of age require drug therapy, even among them, a triple-drug combination is warranted only in a small proportion of subjects. When needed, a combination of statin and aspirin is the most commonly required combination.
authors.affiliation: Dept. of Cardiology, Medanta-The Medicity, Gurgaon, Haryana, USA. rrkasliwal@hotmail.com
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Kasliwal
authors.forename: Manish
authors.initials: M
authors.lastname: Bansal
authors.forename: Rahul
authors.initials: R
authors.lastname: Mehrotra
authors.forename: Vinayak
authors.initials: V
authors.lastname: Agrawal
authors.forename: Sameer
authors.initials: S
authors.lastname: Shrivastava
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011322:Primary Prevention; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin