d18001e7ed4a073f48618a74cba7ef61 306959.pdf e3b6ea611c923a87e12f3eb6a404ac7a40fffb37 306959.pdf a09e20800ad5db47cdf4a404e268b21d12b3a28a411b5fa83b7d92d29f2c5a4d 306959.pdf Title: The Polypill: A New Alternative in the Prevention and Treatment of Cardiovascular Disease Subject: Cardiovascular disease (CVD) is the primary cause of death and disability worldwide. Although age-standardized CVD mortality rates decreased globally by 14.5% between 2006 and 2016, the burden of CVD remains disproportionately higher in low- and middle-income countries compared to high-income countries. Even though proven, effective approaches based on multiple-drug intake aimed at the prevention and treatment of CVD are currently available, poor adherence, early discontinuation of treatment, and suboptimal daily execution of the prescribed therapeutic regimes give rise to shortfalls in drug exposure, leading to high variability in the responses to the prescribed medications. Wald and Law, in their landmark paper published in BMJ 2003, hypothesized that the use of a fixed-dose combination of statins, -blockers, angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, and aspirin (classic Polypill composition) may increase adherence and decrease CVD by up to 80% when prescribed as primary prevention or in substitution of traditional protocols. Since then, many clinical trials have tested this hypothesis, with comparable results. This review aims to describe the available clinical trials performed to assess the impact of fixed-dose combinations on adherence, cost-effectiveness, and the risk factors critical to the onset of CVD. Keywords: polypill; cardiovascular disease; hypertension; LDL cholesterol; randomized clinical trials; efficiency; adherence; cost Author: Enma V. Páez Espinosa, Eugenia Mato Matute, Delia M. Sosa Guzmán and Fadi T. Khasawneh Creator: LaTeX with hyperref Producer: pdfTeX-1.40.24 CreationDate: Wed May 29 09:40:15 2024 CEST ModDate: Wed May 29 09:55:01 2024 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 33 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 654894 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- AIQCCL+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 LWLIVD+EURM10 Type 1 Builtin yes yes yes 16 0 IBORIP+URWPalladioL-Bold Type 1 Custom yes yes yes 21 0 UDMVXZ+URWPalladioL-Roma Type 1 Custom yes yes yes 27 0 CCIXKT+URWPalladioL-Ital Type 1 Custom yes yes yes 32 0 OGLZWV+VnURWPalladioL Type 1 Custom yes yes yes 37 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 53 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 56 0 ENEKAE+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 83 0 ENEKAF+PalatinoLinotype CID TrueType Identity-H yes yes yes 86 0 ENEKAG+PalatinoLinotype TrueType WinAnsi yes yes no 92 0 ENEKAI+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 95 0 ENEKGH+PalatinoLinotype TrueType MacRoman yes yes no 98 0 ENELHC+Calibri,Bold CID TrueType Identity-H yes yes yes 101 0 ENELHD+Calibri CID TrueType Identity-H yes yes yes 107 0 TWBWZR+CMSY10 Type 1 Builtin yes yes yes 125 0 QWMMXD+URWPalladioL-BoldItal Type 1 Custom yes yes yes 130 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-02-07 02:47:27 CET RepresentationInformation: 306959.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-02-06 16:07:30 CET Size: 654894 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 730 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Search Terms Destination: subsection.2.1 Item: Title: Search Strategy and Inclusion Criteria Destination: subsection.2.2 Item: Title: Evaluation of the Studies Destination: subsection.2.3 Item: Title: Results Destination: subsection.2.4 Item: Title: The Polypill: A Brief History Destination: section.3 Item: Title: The Rationale behind the Use of the Polypill in the Management of Hypertension and Hyperlipidemia for the Prevention and Treatment of Cardiovascular Diseases Destination: section.4 Children: Item: Title: Blood Pressure and Cardiovascular Risk Destination: subsection.4.1 Item: Title: Hyperlipidemia and Cardiovascular Risk Destination: subsection.4.2 Item: Title: Current Guidelines for the Management of Hypertension and Dyslipidemia Destination: section.5 Item: Title: The Polypill in the Primary Prevention of Cardiovascular Disease: The Age Factor Destination: section.6 Item: Title: The Cardiovascular Polypill: Bioavailability of the Ingredients and Drug-Drug Interactions Destination: section.7 Item: Title: Efficacy and Tolerability of the Cardiovascular Polypill Destination: section.8 Item: Title: The Polypill in the Management of Cardiovascular Disease in Medium- and Low-Income Countries and the Adherence to Long-Term Therapies Destination: section.9 Item: Title: Discussion Destination: section.10 Item: Title: Conclusions and Future Directions Destination: section.11 Item: Title: References Destination: appendix.A. Info: Title: The Polypill: A New Alternative in the Prevention and Treatment of Cardiovascular Disease Author: Enma V. Páez Espinosa, Eugenia Mato Matute, Delia M. Sosa Guzmán and Fadi T. Khasawneh Subject: Cardiovascular disease (CVD) is the primary cause of death and disability worldwide. Although age-standardized CVD mortality rates decreased globally by 14.5% between 2006 and 2016, the burden of CVD remains disproportionately higher in low- and middle-income countries compared to high-income countries. Even though proven, effective approaches based on multiple-drug intake aimed at the prevention and treatment of CVD are currently available, poor adherence, early discontinuation of treatment, and suboptimal daily execution of the prescribed therapeutic regimes give rise to shortfalls in drug exposure, leading to high variability in the responses to the prescribed medications. Wald and Law, in their landmark paper published in BMJ 2003, hypothesized that the use of a fixed-dose combination of statins, -blockers, angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, and aspirin (classic Polypill composition) may increase adherence and decrease CVD by up to 80% when prescribed as primary prevention or in substitution of traditional protocols. Since then, many clinical trials have tested this hypothesis, with comparable results. This review aims to describe the available clinical trials performed to assess the impact of fixed-dose combinations on adherence, cost-effectiveness, and the risk factors critical to the onset of CVD. 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