Polypills in the fight against cardiovascular diseases: a modern review of effectiveness

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Abstract

Cardiovascular diseases (CVD) are the leading cause of global mortality and the leading cause of disability in the world. The leading modifiable risk factors for CVD - the level of systolic blood pressure (SBP) and low-density lipoprotein (LDL) - are responsible for the development of atherosclerosis and atherosclerotic cardiovascular diseases (ACVD). An important area of the evidence-based movement is a multifactorial approach to managing cardiovascular risk, in particular using fixed-dose combination tablets (polypills) containing antihypertensive drugs and statins, which improve blood pressure control and lipid profiles, and also antiplatelet drugs to prevent further ACVD events. The results of studies and meta-analyses assessing the effect of polypills on CVD risk factors and the main outcomes of cardiovascular morbidity and mortality are presented.

A Cochrane meta-analysis of 13 RCTs that examined the effect of polypills on factors in the primary and secondary prevention patient population, as well as subsequent meta-analyses, confirmed significant reductions in the key modifiable risk factors of SBP and LDL. Subsequently, a comprehensive assessment of the effect of polypills was carried out not only on risk factors, but also on outcomes - cardiovascular morbidity and mortality, including in large RCTs (HOPE-3, PolyIran, TIPS-3) and a number of meta-analyses, including up to 25 RCTs. The results showed a significant reduction in the risk of serious adverse cardiovascular events and mortality in primary or secondary prevention against the background of polypills containing antihypertensive drugs and statins, and more pronounced in primary prevention. There was an increase in adherence to polypill therapy, with no significant difference in the frequency of adverse reactions compared to conventional therapy. Fixed combination therapy is especially important for the treatment of hypertension. Moreover, modern trends are the use of combinations of 3 and 4 antihypertensive drugs in half and quarter dosages (quadropills), which, due to the additive effect, increases blood pressure control.

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About the authors

Marina V. Leonova

Interregional public organization Association of Clinical Pharmacologists (Moscow branch)

Author for correspondence.
Email: anti23@mail.ru
ORCID iD: 0000-0001-8228-1114
SPIN-code: 3281-7884

Dr. Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Natural Sciences, Member of the Organization

Russian Federation, Moscow

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