Frontiers of cardiovascular polypills: From atherosclerosis and beyond

Abstract

Fixed-dose combination (FDC) therapies (also known as polypills) remain underutilized in clinical practice despite over two decades of evidence from randomized controlled trials demonstrating increased adherence to multidrug therapy, improved cardiovascular disease (CVD) risk factor control, and lower incidence of cardiovascular events. Evidence demonstrates that FDC-based implementation strategies can substantially complement and augment current strategies for CVD risk prevention globally. The next decade is likely to extend the frontier of cardiovascular FDC therapies, particularly given expected advances in FDC manufacturing technology and accessibility. FDC-based anti-hypertensive therapies are emerging as integral components of a pragmatic blood pressure lowering strategy. Cardiovascular FDCs are rapidly approaching its coming of age, transforming from heavily hyped research tools to pragmatic clinical instruments. This review evaluates the current evidence for cardiovascular FDCs, barriers to current use, and potential next generation advances.

Keywords: Atherosclerosis; Cardiovascular disease; Fixed dose combination; Hypertension; Polypill; Prevention.

Conflict of interest statement

Declaration of Competing Interest: George Health Enterprises, a part-owned commercial arm of The George Institute for Global Health, has received investment funds to develop fixed-dose combination products containing aspirin, statin, and blood pressure lowering drugs and has submitted a patent for the treatment of hypertension. AA plans to submit a patent for heart failure polypills.

Copyright © 2021. Published by Elsevier Inc.

Figures

Fig. 1.

Cardiovascular event reduction, fixed dose combination vs control [–18] ASA: aspirin.

Fig. 2.

Placebo-controlled systolic blood pressure lowering of combinations and doses of blood pressure medications. [30,41,66,67].

Fig. 3.

Mean blood pressure lowering over time in the TRIUMPH trial of triple low-dose combination as initial/early treatment vs usual care for hypertension [40].