Is a “polypill” the answer to adherence in patients with cardiovascular disease (CVD)? Long-term medication adherence is notoriously poor in these patients. Even in high-income countries, adherence rates are only 50% in patients with coronary disease and 35% in those with those a history of stroke. Polypills combine several cardiovascular medications in one, including aspirin, a statin, and one or more blood pressure medications. A recent study was designed to see if these fixed-dose combination (FDC) pills would improve compliance, LDL cholesterol, and blood pressure levels compared to usual care. Two polypills were evaluated in the study. The first pill contained aspirin 75 mg, simvastatin 40 mg, lisinopril 10 mg, and atenolol 50 mg. The second pill substituted hydrochlorothiazide 12.5 mg for atenolol. About 1000 patients received one of the FDCs with about 1000 controls continuing on usual care. After an average follow-up of 15 months, adherence was higher with the FDC vs usual care (86% vs 65%, P < 0.001), but there were only modest reductions in systolic blood pressure with FDC of about 2.6 mmHg and also modest reductions in LDL cholesterol of 4.2 mg/dL vs usual care. Subgroups of patients who showed poor adherence at baseline had higher levels of improvement in blood pressure and LDL cholesterol. There was no significant difference in cardiovascular events (5% FDC vs 3.5% usual care; relative risk, 1.45; 95% CI, 0.94-2.24; P = 0.09). The authors conclude that among patients at high risk of CVD, use of a FDC “polypill” improved medication adherence with small improvements in systolic blood pressure and LDL cholesterol (JAMA 2013;310:918-929). n
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