Projected Impact of Polypill Use Among US Adults
Projected Impact of Polypill Use Among US Adults
Background Polypills, which include multiple medications for reducing cardiovascular disease (CVD) risk in a single pill, have been proposed for population-wide use. The number of US adults eligible for polypills and potential benefits are unknown.
Methods The National Health and Nutrition Examination Survey 2003–2004 and 2007–2008 were analyzed to estimate treatment rates for medications proposed for inclusion in polypills (aspirin, statin, an angiotensin-converting enzyme [ACE] inhibitor, and a thiazide-type diuretic for those without and a β-blocker for those with a history of myocardial infarction) among US adults. The number of coronary heart disease (CHD) and stroke events potentially prevented through polypill use was projected by published meta-analyses and 3 large population-based cohort studies. Two polypill eligibility criteria were analyzed: (1) US adults ≥55 years and (2) US adults with a history of CVD.
Results There are 67.6 million US adults ≥55 years and 15.4 million US adults with a history of CVD and, thus, eligible for polypills using the 2 outlined criteria. In 2007 to 2008, 37.3% of US adults ≥55 years and 57.0% of those with a history of CVD were taking statins. Use of other polypill medications was also low. Polypill use by US adults aged ≥55 years is projected to potentially prevent 3.2 million CHD events and 1.7 million strokes over 10 years. Among those with a history of CVD, the potential to prevent of 0.9 million CHD events and 0.5 million strokes is projected.
Conclusions Polypills have the potential to lower CVD incidence substantially among US adults.
In 2001, participants in a meeting of the World Health Organization and Wellcome Trust discussed the development of fixed-dose combination medications for the secondary prevention of cardiovascular disease (CVD). In 2003, Wald and Law proposed a "Polypill" that would include multiple pharmacologic therapies aimed at reducing CVD risk by attacking several biological processes simultaneously. Rather than limiting the polypill to secondary prevention, it has been proposed as a public health intervention for use by all adults ≥55 years of age regardless of, and with little to no monitoring of, risk factor levels. Using such a population-based approach, polypills have been projected to result in reductions in coronary heart disease (CHD) and stroke incidence as high as 88% and 80%, respectively. Multiple different polypill formulations have been developed over the past 5 years, with randomized controlled trials of their benefit currently underway.
The purpose of the current analysis was to determine the number of US adults eligible for polypills aimed at reducing CVD risk. Because the criteria for polypill eligibility are not fixed, we investigated the number of eligible US adults using 2 approaches: (1) a population-based approach as recommended by Wald and Law, in which all US adults aged ≥55 years would be recommended polypills and (2) a high-risk approach wherein those with a history of CVD would be recommended a polypill. In addition, we calculated the proportion of each of these populations currently taking cardioprotective medications including aspirin, antihypertensive medications, and statins and projected the number of CHD and stroke events that could be prevented through the administration of polypills in these populations.
Abstract and Introduction
Abstract
Background Polypills, which include multiple medications for reducing cardiovascular disease (CVD) risk in a single pill, have been proposed for population-wide use. The number of US adults eligible for polypills and potential benefits are unknown.
Methods The National Health and Nutrition Examination Survey 2003–2004 and 2007–2008 were analyzed to estimate treatment rates for medications proposed for inclusion in polypills (aspirin, statin, an angiotensin-converting enzyme [ACE] inhibitor, and a thiazide-type diuretic for those without and a β-blocker for those with a history of myocardial infarction) among US adults. The number of coronary heart disease (CHD) and stroke events potentially prevented through polypill use was projected by published meta-analyses and 3 large population-based cohort studies. Two polypill eligibility criteria were analyzed: (1) US adults ≥55 years and (2) US adults with a history of CVD.
Results There are 67.6 million US adults ≥55 years and 15.4 million US adults with a history of CVD and, thus, eligible for polypills using the 2 outlined criteria. In 2007 to 2008, 37.3% of US adults ≥55 years and 57.0% of those with a history of CVD were taking statins. Use of other polypill medications was also low. Polypill use by US adults aged ≥55 years is projected to potentially prevent 3.2 million CHD events and 1.7 million strokes over 10 years. Among those with a history of CVD, the potential to prevent of 0.9 million CHD events and 0.5 million strokes is projected.
Conclusions Polypills have the potential to lower CVD incidence substantially among US adults.
Introduction
In 2001, participants in a meeting of the World Health Organization and Wellcome Trust discussed the development of fixed-dose combination medications for the secondary prevention of cardiovascular disease (CVD). In 2003, Wald and Law proposed a "Polypill" that would include multiple pharmacologic therapies aimed at reducing CVD risk by attacking several biological processes simultaneously. Rather than limiting the polypill to secondary prevention, it has been proposed as a public health intervention for use by all adults ≥55 years of age regardless of, and with little to no monitoring of, risk factor levels. Using such a population-based approach, polypills have been projected to result in reductions in coronary heart disease (CHD) and stroke incidence as high as 88% and 80%, respectively. Multiple different polypill formulations have been developed over the past 5 years, with randomized controlled trials of their benefit currently underway.
The purpose of the current analysis was to determine the number of US adults eligible for polypills aimed at reducing CVD risk. Because the criteria for polypill eligibility are not fixed, we investigated the number of eligible US adults using 2 approaches: (1) a population-based approach as recommended by Wald and Law, in which all US adults aged ≥55 years would be recommended polypills and (2) a high-risk approach wherein those with a history of CVD would be recommended a polypill. In addition, we calculated the proportion of each of these populations currently taking cardioprotective medications including aspirin, antihypertensive medications, and statins and projected the number of CHD and stroke events that could be prevented through the administration of polypills in these populations.