18 Sep Fixed Dose Combination Polypill Can Reduce Barriers to Cardiovascular Care
MedicalResearch.com Interview with:
Daniel Muñoz, M.D, M.P.A
Assistant Professor of Medicine, Division of Cardiology
Medical Director for Quality, Vanderbilt Heart & Vascular Institute
Medical Director, Cardiovascular ICU
Vanderbilt University Medical Center
MedicalResearch.com: What is the background for this study?
Response: Despite advances in the prevention and treatment of cardiovascular disease, it remains the number one global killer of both men and women. Patients face a variety of barriers to getting the care need, including cost and complexity of medication regimens. Innovative strategies are needed to improve the delivery of preventive care, especially when it comes to socio-economically vulnerable individuals. The polypill, a fixed-dose combination of 3 blood pressure lowering medications and a cholesterol lowering medication, may be a strategy for improving cardiovascular disease prevention.
We enrolled 303 patients at a community health center in Mobile, Alabama. Half of the patients were assigned to take a daily polypill, while the other half received their usual medical care. Participants underwent a standard medical exam, blood pressure measurement, and blood cholesterol testing during their initial visit, a 2-month visit, and a 12-month visit.
MedicalResearch.com: What are the main findings?
- Participants in the polypill group experienced a greater reduction in both systolic blood pressure and LDL cholesterol level, as compared with participants in the usual care group. These differences translate to an approximate 25% reduction in the risk of experiencing a cardiovascular event.
- At 12 months, adherence to the polypill regimen, as assessed based on pill counts, was 86%.
- The vast majority of our study participants were African-American (96%), with three quarters reporting an annual income below $15,000.
MedicalResearch.com: What should readers take away from your report?
Response: While there are several important lessons to take away from this study, perhaps the most important is that when it comes to preventing cardiovascular disease, simple strategies like the polypill may offer key advantages for patients who face barriers to accessing medical care. The polypill could be a key tactic in an overall prevention strategy that also incorporates the modern day virtues of precision medicine.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: This study sets up a larger conversation. How do we take what we’ve learned and apply it in a way that helps patients around the country and around the world? We hope that part of the answer will come from applying and studying the polypill strategy in a broad, diverse array of community health centers around the country.
MedicalResearch.com: Is there anything else you would like to add?
Response: Part of our focus in the SCCS Polypill trial was to take a pragmatic clinical research question to a community where the need for innovative, creative prevention strategies may be greatest. Furthermore, patients seeking care at community health centers have traditionally been under-represented in clinical trials. We need to better understand what works and what doesn’t in these settings, so that we can improve outcomes for our fellow citizens who may be most vulnerable.
Daniel Muñoz, M.D., Prince Uzoije, M.D., Cassandra Reynolds, B.S., Roslynn Miller, M.S., David Walkley, Susan Pappalardo, Phyllis Tousey, M.S.P.H., Heather Munro, M.S., Holly Gonzales, M.D., Wenliang Song, M.D., Charles White, M.P.H., William J. Blot, Ph.D.,
September 19, 2019
N Engl J Med 2019; 381:1114-1123
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