Combination pill 'more beneficial for heart disease patients'

Date: Sep-04-2013A single combination pill used to treat blood pressure, cholesterol and platelet control could prove more beneficial for patients with or at risk of heart disease, compared with standard preventive therapy - according to a study published in JAMA.

Researchers from the International Centre for Circulatory Health at Imperial College London conducted a randomized trial involving 2,004 patients in India and Europe who either had heart disease or were at risk for it.

All participants were randomly assigned to either a fixed-dose combination of aspirin, statin and two blood pressure lowering agents, or they continued with their usual care strategy. One group of patients took a fixed-dose combination of 75 mg aspirin, 40 mg simivastatin, 10 mg lisinopril and 50 mg atenolol.

The second group of patients continued with usual care or 75 mg aspirin, 40 mg simivastatin, 10 mg lisinopril and 12.5 mg hydrochlorothiazide.

The researchers say that at the baseline of the study, average blood pressure (BP) was 137/78 mmHg, low-density lipoprotein cholesterol (LDL-C) was 91.5 mg/dL. Additionally, 1,233 of the participants reported use of antiplatelet, statin and two or more medications for lowering blood pressure. Both groups were followed-up for an average of 15 months.
Improved adherence, blood pressure and cholesterol

By the end of the study, 829 of 961 participants in the fixed-dose combination group were adhering to their assigned medication, compared with 621 of 960 patients in the usual care group. This revealed a 21.6% difference in treatment rates.

Overall, results at the end of the study showed that systolic blood pressure and low-density lipoprotein cholesterol were significantly lower in the group with the fixed-dose combination (FDC) treatment, compared with the usual care group.

The study authors say that to the best of their knowledge, "this was the first randomized trial to assess the long-term use of an FDC containing antiplatelet, statin, and BP-lowering drugs compared with usual care in patients with CVD."

They continue:

"The results show that access to FDCs in patients with CVD (cardiovascular disease) or similarly high risk improved adherence, BP, and cholesterol levels. The reductions in BP and cholesterol level were small overall in this comparatively well-treated population but were larger in the subgroup not receiving all recommended treatments at baseline."

The study authors note that the results of this study should be considered in the context of previous trials showing that fixed-dose combinations improve adherence.

"These data suggest that FDCs could play a role in increasing uptake of statins, aspirin, and combination blood pressure-lowering drugs in patients with CVD not currently receiving such treatment," they add.

"Scaled-up access to core cardiovascular medicines is in keeping with national CVD prevention goals in India, Europe, and the United States and could contribute importantly to World Health Organization goals for noncommunicable disease control."

A 2011 trial of the world's first international four-in-one combination pill also showed major benefits, revealing a 50% reduction in predicted heart disease and stroke risks.

Written by Honor Whiteman

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