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A Strategy to Reduce Cardiovascular Disease by More Than 80%

A Strategy to Reduce Cardiovascular Disease by More Than 80% . BMJ   2003;326:1419 (28 June). Why This Paper ?. Pre operative Operative Post Operative. Why This Paper ?. CABG patients only - Majority of our work Majority have BP, Chol, Platelet, poor LV and Homocysteine problems

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A Strategy to Reduce Cardiovascular Disease by More Than 80%

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  1. A Strategy to Reduce Cardiovascular Disease by More Than 80% BMJ  2003;326:1419 (28 June)

  2. Why This Paper ? Pre operative Operative Post Operative

  3. Why This Paper ? • CABG patients only - Majority of our work • Majority have BP, Chol, Platelet, poor LV and Homocysteine problems • One benefit of operation is to reduce tablet number • One tablet only could be beneficial • BP Thiazide • Chol Statin • Poor LV ACEI • Homocysteine folic acid • Recurrent cardiovascular risk Beta Blocker • Platelet Aspirin

  4. Objectives • To determine the combination of drugs and vitamins,and their doses, for use in a single daily pill to achievea large effect in preventing cardiovascular disease with minimaladverse effects. • Four cardiovascular risk factors (low density lipoprotein cholesterol,blood pressure, serum homocysteine, and platelet function) • Regardless of pretreatment levels.

  5. Design • Quantified the efficacy and adverse effects of the proposed formulation from published meta-analyses of randomisedtrials and cohort studies and a meta-analysis of 15 trialsof low dose (50-125 mg/day) aspirin.

  6. Outcome Measures • Proportional reduction in ischaemic heart disease (IHD) events and strokes; life years gained; and prevalenceof adverse effects.

  7. Relative Risks (95% Confidence Intervals) of ischaemic Heart Disease Events and All Strokes (Fatal and Non-fatal) in 15 Randomised Trials of Low Dose Aspirin

  8. Extracranial Adverse Effects of Low Dose Aspirin (50-125 Mg) From the Meta-analysis of 15 Randomised Trials

  9. What Drug and What Dose ? Absolute reductions* (mmol/l) (with 95% confidence intervals) and percentage reductions in serum LDL cholesterol concentration according to statin and daily dose (summary estimates from 164 randomised placebo controlled trials)

  10. Relative distributions of risk factors in men who subsequently died of ischaemic heart disease or stroke and in men who did not. Gaussian distribution fitted to data from a cohort of 22 000 men followed prospectively for 10 years

  11. Effects of the Polypill on the Risks of ischaemic Heart Disease (IHD) and Stroke After Two Years of Treatment at Age 55-64

  12. Expected Benefits in 100 Men and 100 Women Without a Known Vascular Disease Who Start Taking the Polypill at Age 55.

  13. Prevalence of Participants in Randomised Trials Reporting Symptoms Attributable to the Polypill Components

  14. Results - 1 Formulation: • a statin(for example, atorvastatin (daily dose 10 mg) or simvastatin(40 mg)); • three blood pressure lowering drugs (for example,a thiazide, a blocker, and an angiotensin converting enzymeinhibitor), each at half standard dose; • folic acid (0.8 mg);and • aspirin (75 mg). The combination (Polypill) reduces IHD events by 88% (95% confidenceinterval 84% to 91%) and stroke by 80% (71% to 87%).

  15. Results - 2 One thirdof people taking this pill from age 55 would benefit, gainingon average about 11 years of life free from an IHD event orstroke. Summing the adverse effects of the components observedin randomised trials shows that the Polypill would cause symptomsin 8-15% of people (depending on the precise formulation).

  16. Conclusion • The Polypill strategy could largely prevent heartattacks and stroke if taken by everyone aged 55 and older andeveryone with existing cardiovascular disease. • It would beacceptably safe and with widespread use would have a greaterimpact on the prevention of disease in the Western world thanany other single intervention.

  17. Mr Sooraes Question • But you can’t tailor the dose? • Population based relative risk reduction proposal

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