Combination Pharmacotherapy for Cardiovascular Disease

18 October 2005 | Volume 143 Issue 8 | Pages 593-599

Cardiovascular disease (CVD) is the major cause of death in developed countries and is rapidly becoming the major cause of death in the developing world. The increasing rates of obesity and type 2 diabetes, however, may slow the current favorable trends for deaths attributable to CVD in many developed countries. To improve control of risk factors for CVD, Wald and Law proposed a "polypill," containing a statin, a diuretic, a ß-blocker, an angiotensin-converting enzyme inhibitor, aspirin, and folic acid. This combination pharmacotherapy (CP) could be made widely available without treating specific risk factors or individuals. A workshop sponsored by the Centers for Disease Control and Prevention reviewed the concept of CP for both primary and secondary prevention. Combination pharmacotherapy may prove to be efficacious but may also have side effects and poor adherence, which may be greater than or less than that of other preventive approaches. Randomized trials are needed to study these issues, although the design for such trials is uncertain. The ability of CP to prevent CVD in a cost-effective manner must be demonstrated. Minority groups and people with low socioeconomic status in the United States have an increased risk for CVD, and the effectiveness of such pharmacotherapy must be considered for these populations. Combination pharmacotherapy may prove especially effective in the developing world, where studies of CP may precede those done in wealthier countries. Combination pharmacotherapy may have tremendous potential, but additional study and detailed evaluation are necessary.

*For the members of the Combination Pharmacotherapy and Public Health Research Working Group, see the Appendix.

Author and Article Information

From the Emory Center for Outcomes Research, Emory University, Atlanta, Georgia; University of California, San Francisco, San Francisco, California; Centers for Disease Control and Prevention, Atlanta, Georgia; and Constella Group, LLC, Durham, North Carolina.

Note: Lawrence Green, DrPH; William S. Weintraub, MD; K.M. Venkat Narayan, MD, MPH, MBA; David F. Williamson, PhD; Michael Engelgau, MD, MS; and Andrew Friede, MD, MPH, were responsible for the preparation of this manuscript. A full list of the members of the Combination Pharmacotherapy and Public Health Research Working Group is provided in the Appendix.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: William S. Weintraub, MD, Emory Center for Outcomes Research, Emory University Briarcliff Campus, Mailstop 1256/001/1AR, Atlanta, GA 30322; e-mail, wweintr{at}emory.edu.

Read all Rapid Responses

Problems With the Polypill

Mark R Goldstein

Annals Online, 15 Nov 2005 [Full text]