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. 2022:2:925464.
doi: 10.3389/fepid.2022.925464. Epub 2022 Jul 14.

Polypill for atherosclerotic cardiovascular disease prevention in Haiti: Eligibility estimates in a low-income country

Lily D Yan  1   2 , Vanessa Rouzier  2   3 , Jean Lookens Pierre  3 , Eliezer Dade  3 , Rodney Sufra  3 , Mark D Huffman  4   5 , Alexandra Apollon  3 , Stephano St Preux  3 , Miranda Metz  2 , Shalom Sabwa  2 , Béatrice Morisset  6 , Marie Deschamps  3 , Jean W Pape  3 , Margaret L McNairy  1   2
Affiliations

Polypill for atherosclerotic cardiovascular disease prevention in Haiti: Eligibility estimates in a low-income country

Lily D Yan et al. Front Epidemiol. 2022.

Abstract

Background: Multidrug therapy is a World Health Organization "best buy" for the prevention and control of noncommunicable diseases. CVD polypills, including ≥2 blood pressure medications, and a statin with or without aspirin, are an effective, scalable strategy to close the treatment gap that exists in many low- and middle-income countries, including Haiti. We estimated the number of Haitian adults eligible for an atherosclerotic CVD (ASCVD) polypill, and the number of potentially preventable CVD events if polypills were implemented nationally.

Methods: We used cross-sectional data from the Haiti CVD Cohort, a population-based cohort of 3,005 adults ≥18 years in Port-au-Prince, to compare two polypill implementation strategies: high-risk primary prevention and secondary prevention. High-risk primary prevention included three scenarios: (a) age ≥40 years, (b) hypertension, or (c) predicted 10-year ASCVD risk ≥7.5%. Secondary prevention eligibility included history of stroke or myocardial infarction. We then used the 2019 Global Burden of Disease database and published polypill trials to estimate preventable CVD events, defined as nonfatal MI, nonfatal stroke, and cardiovascular death over a 5-year timeline.

Results: Among 2,880 participants, the proportion of eligible adults for primary prevention were: 51.6% for age, 32.5% for hypertension, 19.3% for high ASCVD risk, and 5.8% for secondary prevention. Based on current trends, an estimated 462,509 CVD events (95% CI: 369,089-578,475) would occur among adults ≥40 years in Haiti from 2019-2024. Compared with no polypill therapy, we found 32% or 148,003 CVD events (95% CI: 70,126-248,744) could be prevented by a combined primary and secondary prevention approach in Haiti if polypills were fully implemented over 5 years.

Conclusion: These modeling estimates underscore the potential magnitude of preventable CVD events in low-income settings like Haiti. Model calibration using observed CVD events, costs, and implementation assumptions are future directions.

Clinical trial registration: clinicaltrials.gov, identifier: NCT03892265.

Keywords: Haiti; epidemiology; global health; low-middle income country; preventive cardiology.

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Conflict of interest statement

VR, JPi, JPa, and MMc report a grant from NHLBI R01HL143788. VR reports a grant from NHLBI R01HL143788-S01. MMc reports a grant from the NIH D43TW011972. MH has pending patents for heart failure polypills. The George Institute for Global Health's wholly owned enterprise, George Health Enterprises, has received investment funds to develop fixed-dose combination products containing aspirin, statin and blood pressure lowering drugs. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
ASCVD polypill eligibility in Haiti using the Haiti CVD Cohort (N = 2,880 participants age ≥ 18 years). ASCVD, atherosclerotic cardiovascular disease; CI, confidence intervals; CVD, cardiovascular disease.
See this image and copyright information in PMC

References

    1. Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. . Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. (2020) 396:1204–22. 10.1016/S0140-6736(20)30925-9 - DOI - PMC - PubMed
    1. Geldsetzer P, Manne-Goehler J, Marcus ME, Ebert C, Zhumadilov Z, Wesseh CS, et al. . The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1·1 million adults. Lancet. (2019) 394:652–62. 10.1016/S0140-6736(19)30955-9 - DOI - PubMed
    1. Marcus ME, Ebert C, Geldsetzer P, Theilmann M, Bicaba BW, Andall-Brereton G, et al. . Unmet need for hypercholesterolemia care in 35 low- and middle-income countries: a cross-sectional study of nationally representative surveys. PLoS Med. (2021) 18:e1003841. 10.1371/journal.pmed.1003841 - DOI - PMC - PubMed
    1. Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ. (2003) 326:1419. 10.1136/bmj.326.7404.1419 - DOI - PMC - PubMed
    1. Muñoz D, Uzoije P, Reynolds C, Miller R, Walkley D, Pappalardo S, et al. . Polypill for cardiovascular disease prevention in an underserved population. N Engl J Med. (2019) 381:1114–23. 10.1056/NEJMoa1815359 - DOI - PMC - PubMed

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