Polypill Therapy, Subclinical Atherosclerosis, and Cardiovascular Events—Implications for the Use of Preventive Pharmacotherapy
Open accessAbstract
Objectives This study examines whether the coronary artery calcium (CAC) score can be used to define the target population to treat with a polypill.Background Prior studies have suggested a single polypill to reduce cardiovascular disease (CVD) at the population level.Methods Participants from MESA (Multi-Ethnic Study of Atherosclerosis) were stratified using the criteria of 4 polypill studies (TIPS [The Indian Polycap Study], Poly-Iran, Wald, and the PILL [Program to Improve Life and Longevity] Collaboration). We compared coronary heart disease (CHD) and CVD event rates and calculated the 5-year number needed to treat (NNT) after stratification based on the CAC score.Results Among MESA participants eligible for TIPS, Poly-Iran, Wald, and the PILL Collaboration, CAC = 0 was observed in 58.6%, 54.5%, 38.9%, and 40.8%, respectively. The rate of CHD events among those with CAC = 0 varied from 1.2 to 1.9 events per 1,000 person-years, those with CAC scores from 1 to 100 had event rates ranging from 4.1 to 5.5, and in those with CAC scores >100 the event rate ranged from 11.6 to 13.3. The estimated 5-year NNT to prevent 1 CVD event ranged from 81-130 for patients with CAC = 0, 38-54 for those with CAC scores from 1 to 100, and 18-20 for those with CAC scores >100.Conclusions In MESA, among individuals eligible for treatment with the polypill, the majority of CHD and CVD events occurred in those with CAC scores >100. The group with CAC = 0 had a very low event rate and a high projected NNT. The avoidance of treatment in individuals with CAC = 0 could allow for significant reductions in the population considered for treatment, with a more selective use of the polypill and, as a result, avoidance of treatment in those who are unlikely to benefit.
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- Authors
- Bittencourt, M. S., Blaha, M. J., Blankstein, R., Budoff, M., Vargas, J. D., Blumenthal, R. S., Agatston, A. S., & Nasir, K.
- Affiliations
- Brigham and Women's Hospital (US)
- Johns Hopkins University (US)
- University of California, Los Angeles (US)
- National Institutes of Health (US)
- Baptist Hospital of Miami (US)
- Corresponding author
- Nasir, Khurram
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2014-02
- Volume
- 63
- Issue
- 5
- Pages
- 434-443
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC4174413
- OpenAlex
- W1844872504
- Cited by
- 70
- References
- 31
- Citations by year
- 2025: 4 · 2024: 3 · 2022: 3 · 2021: 5 · 2020: 3 · 2019: 3 · 2018: 1 · 2017: 11 · 2016: 12 · 2015: 13 · 2014: 9 · 2013: 3
- FWCI
- 9.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (UL1TR001079)
- National Heart, Lung, and Blood Institute (L30HL110027)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- polypill, coronary artery calcium, subclinical atherosclerosis, cardiovascular disease prevention, coronary artery disease, number needed to treat, target population selection, Multi-Ethnic Study of Atherosclerosis
- MeSH terms
- Adult, Aged, Aged, 80 and over, Calcinosis, Calcium, Coronary Artery Disease, Coronary Vessels, Drug Therapy, Combination, Ethnicity, Female, Follow-Up Studies, Humans, Male, Middle Aged, Risk Factors, Time Factors, Tomography, X-Ray Computed, United States, Incidence, Prevalence, Coronary Angiography, Risk Assessment, Atherosclerosis
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