Department of Epidemiology and Medicine, University of Alabama at Birmingham, 35294, USA.
Am Heart J. 2011 Apr;161(4):719-25. doi: 10.1016/j.ahj.2010.12.019.
Polypills, which include multiple medications for reducing cardiovascular disease (CVD) risk in a single pill, have been proposed for population-wide use. The number of US adults eligible for polypills and potential benefits are unknown.
The National Health and Nutrition Examination Survey 2003-2004 and 2007-2008 were analyzed to estimate treatment rates for medications proposed for inclusion in polypills (aspirin, statin, an angiotensin-converting enzyme [ACE] inhibitor, and a thiazide-type diuretic for those without and a β-blocker for those with a history of myocardial infarction) among US adults. The number of coronary heart disease (CHD) and stroke events potentially prevented through polypill use was projected by published meta-analyses and 3 large population-based cohort studies. Two polypill eligibility criteria were analyzed: (1) US adults ≥55 years and (2) US adults with a history of CVD.
There are 67.6 million US adults ≥55 years and 15.4 million US adults with a history of CVD and, thus, eligible for polypills using the 2 outlined criteria. In 2007 to 2008, 37.3% of US adults ≥55 years and 57.0% of those with a history of CVD were taking statins. Use of other polypill medications was also low. Polypill use by US adults aged ≥55 years is projected to potentially prevent 3.2 million CHD events and 1.7 million strokes over 10 years. Among those with a history of CVD, the potential to prevent of 0.9 million CHD events and 0.5 million strokes is projected.
Polypills have the potential to lower CVD incidence substantially among US adults.
复方药是指将多种降低心血管疾病风险的药物混合在一片药丸中，旨在用于人群广泛使用。尚不清楚有多少美国成年人符合服用复方药的条件，以及潜在的获益情况。
我们分析了 2003-2004 年和 2007-2008 年的国家健康和营养调查数据，以评估美国成年人服用复方药（阿司匹林、他汀类药物、血管紧张素转换酶抑制剂和噻嗪类利尿剂，无心肌梗死史者用；β受体阻滞剂，有心肌梗死史者用）的治疗率。通过发表的荟萃分析和 3 项大型基于人群的队列研究，预估服用复方药预防冠心病（CHD）和中风的潜在事件数量。我们分析了 2 种服用复方药的标准：（1）55 岁以上的美国成年人；（2）有 CVD 史的美国成年人。
55 岁以上的美国成年人有 6760 万人，有 CVD 史的成年人有 1540 万人，因此，这 2 种标准都符合服用复方药的条件。2007-2008 年，37.3%的 55 岁以上成年人和 57.0%的有 CVD 史的成年人服用他汀类药物。其他复方药的使用率也较低。55 岁以上的美国成年人服用复方药预计在 10 年内可预防 320 万例 CHD 事件和 170 万例中风。对于有 CVD 史的成年人，预计可预防 90 万例 CHD 事件和 50 万例中风。
复方药有望大幅降低美国成年人的 CVD 发病率。
