Improving adherence to essential medicines for the prevention of cardiovascular disease

Abstract

Background: Cardiovascular disease (CVD) is the leading cause of mortality. Most people with cardiovascular disease don’t take statin, anti-platelet and blood pressure lowering medications long-term despite proven benefits. Fixed dose combination pills (‘polypills’) may improve adherence but uncertainty exists about benefits, and potential harms, in different populations. Methods: An individual patient data meta-analysis was conducted of 3,140 patients across three trials in 6 countries comparing polypill-based care with usual care in individuals with CVD or high calculated cardiovascular risk. Primary outcomes were self-reported adherence to combination therapy (anti-platelet, statin and at least two BP lowering medications), and change in systolic blood pressure (SBP) and LDL-cholesterol at 12 months. Findings: At 12 months, vs usual care, participants in the polypill arm had higher adherence to combination therapy (80% vs 50%, RR1.58; 1.32 to 1.90), had lower SBP (-2.5 mmHg; -4.5 to -0.4) and lower LDL-cholesterol (-0.09 mmol/L; -0.18 to 0.0). Baseline treatment levels were a major effect modifier with largest improvements occurring in those undertreated or on no treatment at baseline. Conclusion: Among patients not taking the full complement of recommended CVD preventive therapies, use of a polypill based strategy has large potential benefits in reducing global morbidity and mortality.