title: Polypill treatments for cardiovascular diseases.
abstract: Cardiovascular disease (CVD) is the leading cause of mortality globally. Effective CVD preventive medications are available including statin, blood pressure-lowering and antiplatelet medications; however most people do not take these drugs long term. Fixed-dose combination pills ("polypills") have been shown, in several clinical trials, to improve adherence to these recommended medications, with corresponding improvements in risk factors such as blood pressure and LDL-cholesterol. In patients not taking all modalities of recommended CVD preventive therapies, polypill-based strategies could importantly contribute to global CVD control strategies. The largest benefits are seen in those who are under-treated at baseline, rather than those who are already taking the individual components separately: simplified step-up is more important than pill count reduction. Despite the potential benefits for patients and payers, only a few polypills are available due to market failure in the funding of research and development for affordable non-communicable disease medicines. Regulatory paradigms have focused on substitution indications among patients already taking component medications; however, this is the population that is likely to receive the least benefit from a polypill-based strategy. Greater health impact is likely if focus is given to patients who have indications for all polypill components, but currently do not receive the benefits of recommended medicines long term.
authors.affiliation: a Senior Research Fellow , The George Institute for Global Health, University of Sydney , Level 10, KGV Building, 83 - 117 Missenden Rd, Camperdown , NSW 2050 , Australia.
authors.forename: Ruth
authors.initials: R
authors.lastname: Webster
authors.affiliation: b Professor of Global Health , The George Institute for Global Health, University of Sydney , Level 13, 321 Kent St, Sydney , NSW 2000 , Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Rodgers
mesh_terms: D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000191:economics; D004338:Drug Combinations; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D012307:Risk Factors
chemical_list: D002317:Cardiovascular Agents; D004338:Drug Combinations; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors
keywords: cardiovascular disease; cardiovascular prevention; fixed dose combination; polypills