Implementation of a simple age‐based strategy in the prevention of cardiovascular disease: the Polypill approach

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Abstract
Background A combination of medications that simultaneously reduce several cardiovascular risk factors in people above a specified age, without selection based on risk factor measurement, has been proposed as a simple strategy for reducing the risk of cardiovascular disease and shown to be effective in randomized trials (the Polypill approach). Aims To assess acceptance of the Polypill approach and adherence to preventive treatment among individuals taking part in a cardiovascular disease prevention service. Methods Daily treatment with simvastatin (40 mg), amlodipine (2.5 mg), bendroflumethiazide (1.25 mg), lisinopril (5 mg) [or candesartan (4 mg) if cough was reported] and folic acid (0.8 mg) was offered, as separate components, to people ≥ 55 years with no history of cardiovascular, renal or liver disease. An audit of adverse effects, adherence and requests for blood pressure and cholesterol measurement was determined by telephone consultation. Results Between 2006 and 2010, 269 participants started treatment with the Polypill components. Follow-up ranged from 3 to 48 months (mean 20). A total of 222 participants (83%) adhered to treatment, including 30 (11%) who switched from the angiotensin-converting enzyme inhibitor (lisinopril) to the angiotensin receptor blocker (candesartan) because of cough. Ten participants (4%) continued to take treatment but stopped taking one or more drugs because of other symptoms, and 37 (14%) stopped all treatment, eight because of adverse effects and 29 for non-medical reasons. No one requested a blood pressure or cholesterol measurement. Conclusion This is the first demonstration of the application of the Polypill approach in practice. The method was accepted and the Polypill components were well tolerated, with good adherence and no demand for information about risk factors.

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