Cardiovascular outcomes are better in patients taking a polypill, highlighting the importance of adherence.
Convenience and simplicity could have major benefits for health outcomes, thanks to better adherence, new cardiovascular research suggests.
Research on a combined aspirin, ACE inhibitor and statin pill found that frequency of cardiovascular events was significantly lower in the treatment group, compared with usual care.
“By simplifying treatment complexity and improving availability, the use of a polypill is a widely applicable strategy to improve accessibility and adherence to treatment, thus decreasing the risk of recurrent disease and cardiovascular death,” the authors wrote in the NEJM.
They said that adherence to secondary prevention drugs was estimated to be around 50%, and that this lack of adherence was associated with poorer outcomes.
To understand the role that combined medication could play in addressing this problem, the researchers analysed the rates of major cardiovascular events in elderly patients taking a formulation containing aspirin (100mg), ramipril (2.5, 5 or 10mg) and atorvastatin (20 or 40mg).
The phase III randomised controlled trial of 2500 patients, who had had myocardial infarction within the previous six months, found that one in 10 patients taking the polypill either died from a CV event or had a nonfatal myocardial infarction, nonfatal ischaemic stroke or urgent coronary revascularisation. In contrast, that proportion rose to one in eight among the usual care group, meaning the combined pill was linked to a 25% reduction in risk.
Overall, the polypill treatment strategy resulted in a lower risk of major adverse cardiovascular events compared to the usual-care strategy outlined by current European Society of Cardiology guidelines.
Adverse events were similar across groups.
“The risk reductions that were observed in the polypill group may be explained partly by increased adherence,” the authors wrote.
They pointed to previous research that found major CV events were 27% less likely among patients with higher adherence to prescribed drugs compared to those with lower adherence. Separate research on a cardiovascular polypill identified similar reductions.
“A polypill strategy has been shown to improve medication adherence by virtue of treatment simplification.”
