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Potent multidrug pill for cardiovascular disease

Globally, cardiovascular disease (CVD) is a leading cause of mortality, costing European economies about EUR 192 billion annually. Most CVD patients show poor long-term adherence to their treatment regimen due to factors such as complexity, physician inertia and cost.

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To successfully lower systolic blood pressure (SBP) and low-density lipoprotein (LDL) levels in CVD patients, the barriers to adherence and treatment gaps need to be overcome. To achieve this, the EU-funded randomised, blinded clinical trial 'Use of a multidrug pill in reducing cv events' (UMPIRE) was initiated in Europe and India. The trial enrolled 1 004 patients in Europe and 1 000 patients in India. Some CVD patients were dosed with a single pill having a fixed-dose combination (FDC) of several drugs. The 'polypills' contained aspirin 75 mg, simvastatin 40 mg, lisinopril 10 mg, and either atenolol 50 mg or hydrochlorothiazide 12.5 mg. The FDC-taking patient compliance as well as SBP and LDL levels were compared to those patients taking their usual cocktail of medications. Despite underestimation of patient adherence, trial outcomes revealed that using FDCs significantly improved patient compliance and effectively lowered SBP and LDL levels. Barriers to adherence such as complexity were successfully overcome through packaged delivery, low cost, simplified prescription dosage and consumption. Increased patient adherence demonstrably off-set the risk of sub-optimal risk-factor control with a significant reduction seen in cholesterol and BP levels. This randomised trial was the first of its kind to assess the long-term use of FDCs on CVD patients. FDC treatment strategy would also lower costs of medication and overall health care, thus increasing patient acceptance. Implementation of FDC strategy in health policies for CVD could improve patient access to care, and reduce treatment inequalities and associated health care costs even in resource-poor countries. Ultimately, CVD patient outcomes and quality of life will considerably improve with FDC implementation.

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