title: Starting the polypill: the use of a single age cut-off in males and females.
abstract: Objective Age screening and preventive medication for future myocardial infarction and stroke has been previously described. We aimed to ascertain whether different age cut-offs are needed for males and females. Methods We determined five parameters for each sex according to age cut-off: detection rate (sensitivity), false-positive rate, proportion of the population eligible for treatment with a polypill, proportion who benefit from taking a polypill (simvastatin 20 mg, losartan 25 mg, hydrochlorothiazide 12.5 mg, amlodipine 2.5 mg), and among these, years of life gained without a first myocardial infarction or stroke. Results Approximately one-third benefit, regardless of the age cut-off. For males and females combined, using ages 40 and 80, the detection rates are 98% and 52%, false-positive rates are 51% and 7%, population percentages eligible for treatment are 52% and 7%, and years of life gained without a first myocardial infarction or stroke are 8.4 and 3.6. Using age 50, detection rates are 93% (males) 98% (females), false-positive rates 37% (males) 40% (females), percentage of the population eligible for treatment 38% (males) 41% (females), percentage who benefit 35% (males) 33% (females), and years of life gained without an event 8.5 (males) 7.0 (females). At a given age cut-off, the sex differences are relatively small. Conclusion A single age cut-off can be used for both sexes.
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wald
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Luteijn
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Joan K
authors.initials: JK
authors.lastname: Morris
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage; D019808:Losartan / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D011314:Preventive Health Services; D019821:Simvastatin / Q000008:administration & dosage; D013222:State Medicine; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D002317:Cardiovascular Agents; D004338:Drug Combinations; D006852:Hydrochlorothiazide; D019821:Simvastatin; D019808:Losartan
keywords: Polypill; cardiovascular disease; myocardial infarction; screening; stroke