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Researchers press for combo therapy of aspirin, statins & two BP medications to stall risk of CVD

Nandita Vijay, Bengaluru
Friday, September 3, 2021, 08:00 Hrs  [IST]

A recent study conducted by St. John’s Medical College and Research, Bengaluru and the Population Health Research Institute (PHRI), McMaster University in Canada have emphasised on prescribing a combination therapy or a poly pill in a fixed dose combination (FDC) of aspirin, statins and at least two blood pressure medications to slash the risk of fatal cardiovascular disease (CVD) by more than half.

The recently concluded international study funded by PHRI involved investigators from 13 countries and included participants from 26 countries. FDC treatment strategies trialled by the researchers to substantially reduce CVD are called ‘polypills’ when used in a single-tablet drug formula.

The concept of a combination pill was first proposed exactly 20 years ago as a strategy to substantially reduce CVD in the population and also in those who already have had a previous heart attack or stroke. Early trials demonstrated improved patient adherence to treatment regimens and better risk factor control with a polypill, compared to the use of single drugs, usual care, or placebos. Given that all the components of the polypill are generic and low cost, polypills can be provided to people at modest costs and are likely to be very cost effective, said the researchers.

FDCs were administered with and without aspirin versus control groups in over 18,000 patients without prior CVD from three large clinical trials. FDCs including aspirin cut the risk of heart attacks by 53 percent, stroke by 51 per cent, and fatality deaths from CVD by 49 per cent.

The study published by The Lancet was concurrently presented at the European Society of Cardiology Congress by Phil Joseph, associate professor of medicine, McMaster University, investigator, PHRI, cardiologist, Hamilton Health Sciences and lead author.

“This combination, either given separately or combined as a polypill, reduced fatal and non-fatal CVD events,” said Salim Yusuf, executive director, PHRI and Distinguished University Professor, McMaster and senior author and the Principal Investigator of the study.

Representing the St. John’s Medical College and Research Institute Dr. Prem Pais and Dr, Denis Xavier, led a series of trials in over 60 hospitals in India to evaluate different polypills.

Dr. Pais said, “Our group in St. John’s has been collaborating with PHRI for almost two decades in the development of the polypill concept. We are convinced that the polypill concept is a practical and powerful weapon in from CVDs and strokes”.

Dr. Xavier said, “This metanalysis of polypill trials has confirmed the efficacy of the polypill. Several physicians at 60 hospitals in India worked hard to conduct these research studies. We now hope to work at advocating its inclusion in the county’s health programme”.

“India has a huge burden of young onset type 2 diabetes and premature cardiovascular disease. In India adherence to drug treatments is very poor and therefore a polypill can help to save millions of lives” said Dr V Mohan leading diabetologist and director, Madras Diabetes Research Foundation one of the sites where the study was carried out.

Dr P P Mohanan, president, Cardiology Society of India said, “The phenomenal protection offered by polypill against cardiovascular disease is a gratifying. There shouldn’t be a debate on its usefulness now and India with the maximum number of CVD patients is going to benefit most. Let this important information get propagated to every treating clinician across the globe.”


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