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Using fixed dose combination drugs to reduce cardiovascular disease
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Despite major medical advances in the prevention and treatment of cardiovascular diseases (CVDs), use of life-saving medicines is inadequate in low- and middle-income countries (LMICs), and below the desired standard in high-income countries (HICs). Using three to four essential medications (aspirin, beta-blockers, diuretics, statins, ACE-inhibitors) can substantially reduce CVD-related mortality, especially in secondary prevention.
However, the majority of people who have had a CVD event are under-treated in both HICs and LMICs. Combining these drugs (all of which are available in cost-effective generic substitutions) into one single medicine – known as a ‘fixed dose combination’ (FDC) or polypill – can improve affordability, access to treatment and patient adherence to drug regimens, as well as simplify physician prescribing of medications.
Although numerous studies have supported a polypill strategy for secondary prevention, there has been little progress in its implementation worldwide. Scaling up a polypill strategy worldwide could contribute to the WHO target of reducing premature mortality from non-communicable diseases (including CVD) by 25% by the year 2025 in a cost-effective manner, and would help to meet the goal for coverage of preventive medications in at least 50 percent of the population with symptomatic CVD.
The World Heart Federation (WHF) convenes worldwide experts to improve access to CVD medicines and in particular to support a polypill strategy for CVD secondary prevention by conducting advocacy activities, backing the inclusion of the polypill on the WHO Essential Medicines List, engaging in communication efforts and aligning it with other related initiatives such as the new Coalition for Access to NCD Medicine & Products.
In line with our commitment to drive a 25% reduction of CVD premature mortality by 2025, WHF will focus its efforts on three World Health Organization (WHO) targets around secondary prevention, hypertension and tobacco control. The primary vehicle for this will be the WHF roadmaps, frameworks that identify roadblocks on the way to 25 by 25 and bring together stakeholders with the objective of determining, prioritizing and implementing solutions to reduce premature CVD deaths in countries, in a collaborative and consultative approach. The WHF secondary prevention and cholesterol roadmaps identified the use of the polypill as a key strategy.
Wellcome commissioned Global Life Sciences to assess and report on the current landscape for the polypill in the primary and secondary prevention of cardiovascular diseases (CVD), with the key aim of providing an update on the accumulated evidence in this field. The assessment was conducted based on secondary sources – reviewing the current literature and primary sources – through qualitative interviews with eight key opinion leaders. The scope of the report included commercial, competitor, regulatory, ethical, and clinical dimensions, and an assessment of current hurdles to the adoption of the polypill. The report findings were presented and discussed by the attendees of the Third Cardiovascular Combination Pharmacotherapy Global Summit, Mexico City, 8 June 2016, hosted by the World Heart Federation.
The report showed that since the polypill concept was introduced in 2001, opinion still remains divided on whether the polypill is a viable public health tool for the prevention of cardiovascular incidence, and only a handful of polypill products have been approved.
Click here for a pdf version of the report