Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Sci Rep. 2021 Mar 25;11(1):6880. doi: 10.1038/s41598-021-84455-8.
The polypill has been advocated for cardiovascular disease (CVD) management. The fraction of the population who could benefit from the polypill in Switzerland is unknown. Assess (1) the prevalence of subjects (a) eligible for the polypill and (b) already taking a polypill equivalent; and (2) the determinants of polypill intake in the first (2009-2012) and second follow-ups (2014-2017) of a population-based prospective study conducted in Lausanne, Switzerland. The first and the second follow-ups included 5038 and 4596 participants aged 40-80 years, respectively. Polypill eligibility was defined as having a high CVD risk as assessed by an absolute CVD risk ≥ 5% with the SCORE equation for Switzerland and/or presenting with CVD. Four polypill equivalents were defined: statin + any antihypertensive with (A) or without (B) aspirin; statin + calcium channel blocker (CCB) (C); and statin + CCB + angiotensin-converting enzyme inhibitor (D). The prevalence of polypill eligibility was 20.6% (95% CI 19.5-21.8) and 27.7% (26.5-29.1) in the first and second follow-up, respectively. However, only around one-third of the eligible 29.5% (95% CI 26.7-32.3) and 30.4% (27.9-33.0) respectively, already took the polypill equivalents. All polypill equivalents were more prevalent among men, elderly and in presence of CVD. After multivariable adjustment, in both periods, male gender was associated with taking polypill equivalent A (OR: 1.93; 95% CI 1.45-2.55 and OR: 1.67; 95% CI 1.27-2.19, respectively) and polypill equivalent B (OR: 1.52; 95% CI 1.17-1.96 and OR: 1.41; 95% CI 1.07-1.85, respectively). Similarly, in both periods, age over 70 years, compared to middle-age, was associated with taking polypill equivalent A (OR: 11.71; CI 6.74-20.33 and OR: 9.56; CI 4.13-22.13, respectively) and equivalent B (OR: 13.22; CI 7.27-24.07 and OR: 20.63; CI 6.51-56.36, respectively). Former or current smoking was also associated with a higher likelihood of taking polypill equivalent A in both periods. A large fraction of the population is eligible for the polypill, but only one-third of them actually benefits from an equivalent, and this proportion did not change over time.
在心血管疾病 (CVD) 管理中，多效药丸已被提倡使用。瑞士有多少人可以从多效药丸中受益尚不清楚。评估（1）有资格服用多效药丸的人群（a）和（b）已经服用多效药丸等效物的人群的患病率；以及（2）在瑞士洛桑进行的基于人群的前瞻性研究的第一（2009-2012 年）和第二（2014-2017 年）随访中，多效药丸摄入的决定因素。第一和第二随访分别包括年龄在 40-80 岁之间的 5038 名和 4596 名参与者。多效药丸的资格定义为使用瑞士 SCORE 方程评估的高 CVD 风险（绝对 CVD 风险≥5%），或存在 CVD。定义了四种多效药丸等效物：他汀类药物+任何具有（A）或不具有（B）阿司匹林的降压药；他汀类药物+钙通道阻滞剂 (CCB) (C)；以及他汀类药物+CCB+血管紧张素转换酶抑制剂 (D)。在第一次和第二次随访中，多效药丸的资格患病率分别为 20.6%（95%CI 19.5-21.8）和 27.7%（26.5-29.1）。然而，只有约三分之一的合格者 29.5%（95%CI 26.7-32.3）和 30.4%（27.9-33.0）分别服用了多效药丸等效物。所有多效药丸等效物在男性、老年人和存在 CVD 时更为常见。在多变量调整后，在两个时期，男性性别均与服用多效药丸等效物 A（OR：1.93；95%CI 1.45-2.55 和 OR：1.67；95%CI 1.27-2.19）和多效药丸等效物 B（OR：1.52；95%CI 1.17-1.96 和 OR：1.41；95%CI 1.07-1.85）相关。同样，在两个时期，与中年相比，70 岁以上的年龄与服用多效药丸等效物 A（OR：11.71；CI 6.74-20.33 和 OR：9.56；CI 4.13-22.13）和等效物 B（OR：13.22；CI 7.27-24.07 和 OR：20.63；CI 6.51-56.36）相关。以前或现在吸烟也与两个时期服用多效药丸等效物 A 的可能性增加有关。很大一部分人群有资格服用多效药丸，但只有三分之一的人实际受益于多效药丸等效物，而且这一比例并没有随着时间的推移而改变。
