PEOPLE WITH HEART disease are much more likely to take preventative medications if they’re combined in a single pill, according to the results of a clinical trial presented at the latest American Heart Association’s Scientific Sessions.
Researchers studied whether changing the delivery of several medications into one fixed-dose combination pill might improve people’s adherence to preventative medications and, therefore, improve blood pressure and cholesterol control.
As part of the study, researchers followed more than 2,000 men and women, aged 62 on average, with cardiovascular disease in Europe and India for an average 15 months. Half of the participants were given a combination pill of aspirin, a cholesterol-lowering agent (statin) and two blood pressure-lowering drugs. The other half took their medications as usual, with multiple pills and doses.
Adherence improved by ‘a third’
The subject group taking a single pill showed improved adherence by a third and had improved blood pressure and cholesterol levels compared to those taking multiple pills, researchers noted.
Alice Stanton, lead Irish Investigator, Co-author and Professor of Molecular and Cellular Therapeutics at RCSI, Dublin, said the findings would also likely apply to Americans: “We deliberately chose two quite different settings – Western Europe and India, with half the patients from each region, although the trial did include well-treated populations in both locations. Seeing broadly similar findings in each region suggests generalisability”.
In high income nations, such as the US, about 50 per cent of people take all the cardiovascular medications they need, while in low and middle-income countries only 5 per cent to 20 per cent do.
Large numbers ‘fall out of the habit’
Leader of the study Simon Thom, MD, FRCP, said that this is the first time the impact of a fixed-dose combination strategy has been tested in people with cardiovascular disease. Thom, also a professor of cardiovascular medicine and pharmacology at Imperial College London, added:
People who have suffered heart attacks or strokes or those at high risk of such problems need to take preventive medications, including antiplatelet drugs (such as aspirin), cholesterol-lowering and blood pressure-lowering drugs.
But the reality is that large numbers of people in this high-risk category get out of the habit of taking the recommended medications,” Thom said. “This happens for a variety of reasons; some of which may be corrected by a single, simple, fixed dose combination pill – a combination known as a ‘polypill.’
The fixed dose combination strategy for cardiovascular disease prevention has as been met with some uncertainty: while many physicians have suggested that adherence to preventative medicines might be improved, some suggest that the reduced flexibility associated with adjusting doses and the number of individual agents could have offset the benefits offered.
“This trial showed improvements in adherence being paralleled by improvements in blood pressure and cholesterol, despite the control group in the trial being treated much better than average,” Stanton said.
Similar trials are now being conducted in Australia and New Zealand.
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