Projected impact of polypill use among US adults: Medication use, cardiovascular risk reduction, and side effects

Abstract

Background: Polypills, which include multiple medications for reducing cardiovascular disease (CVD) risk in a single pill, have been proposed for population-wide use. The number of US adults eligible for polypills and potential benefits are unknown.

Methods: The National Health and Nutrition Examination Survey 2003-2004 and 2007-2008 were analyzed to estimate treatment rates for medications proposed for inclusion in polypills (aspirin, statin, an angiotensin-converting enzyme [ACE] inhibitor, and a thiazide-type diuretic for those without and a β-blocker for those with a history of myocardial infarction) among US adults. The number of coronary heart disease (CHD) and stroke events potentially prevented through polypill use was projected by published meta-analyses and 3 large population-based cohort studies. Two polypill eligibility criteria were analyzed: (1) US adults ≥55 years and (2) US adults with a history of CVD.

Results: There are 67.6 million US adults ≥55 years and 15.4 million US adults with a history of CVD and, thus, eligible for polypills using the 2 outlined criteria. In 2007 to 2008, 37.3% of US adults ≥55 years and 57.0% of those with a history of CVD were taking statins. Use of other polypill medications was also low. Polypill use by US adults aged ≥55 years is projected to potentially prevent 3.2 million CHD events and 1.7 million strokes over 10 years. Among those with a history of CVD, the potential to prevent of 0.9 million CHD events and 0.5 million strokes is projected.

Conclusions: Polypills have the potential to lower CVD incidence substantially among US adults.

Figure 1

Percentage (top panel) and number (bottom panel) of US adults expected to have a coronary heart disease event (left panels) or stroke (right panels) over the next 10 years with and without us e of polypills. History of cardiovascular disease (CVD) Includes individuals with a history of myocardial infarction, coronary heart disease, or stroke Without Polypill – Numbers are the product of the population size, estimated from NHANES 1999-2004, times the 10-year coronary heart disease incidence rates estimated using participants in the population-based Framingham Offspring Study, Atherosclerosis Risk in Communities study (ARIC) and the Cardiovascular Health Study (CHS) meeting the listed criteria. With Polypill – Calculated as the observed coronary heart disease and stroke event rates in the Framingham Offspring Study, ARIC and CHS multiplied by the event reductions associated with the polypill medications as described in the methods section.