Polypill therapy, subclinical atherosclerosis, and cardiovascular events - Implications for the use of preventive pharmacotherapy: MESA (Multi-Ethnic Study of Atherosclerosis)

Márcio Sommer Bittencourt, Michael J. Blaha, Ron Blankstein, Matthew Budoff, Jose D. Vargas, Roger S. Blumenthal, Arthur S. Agatston, Khurram Nasir

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)434-443
Number of pages10
JournalJournal of the American College of Cardiology
Volume63
Issue number5
DOIs
StatePublished - Feb 11 2014
Externally publishedYes

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Atherosclerosis
Coronary Vessels
Calcium
Drug Therapy
Numbers Needed To Treat
Cardiovascular Diseases
Therapeutics
Coronary Disease
Iran
Health Services Needs and Demand
Population

Keywords

  • polypill
  • risk stratification
  • subclinical atherosclerosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Polypill therapy, subclinical atherosclerosis, and cardiovascular events - Implications for the use of preventive pharmacotherapy : MESA (Multi-Ethnic Study of Atherosclerosis). / Bittencourt, Márcio Sommer; Blaha, Michael J.; Blankstein, Ron; Budoff, Matthew; Vargas, Jose D.; Blumenthal, Roger S.; Agatston, Arthur S.; Nasir, Khurram.

In: Journal of the American College of Cardiology, Vol. 63, No. 5, 11.02.2014, p. 434-443.

Research output: Contribution to journalArticle

Bittencourt, Márcio Sommer ; Blaha, Michael J. ; Blankstein, Ron ; Budoff, Matthew ; Vargas, Jose D. ; Blumenthal, Roger S. ; Agatston, Arthur S. ; Nasir, Khurram. / Polypill therapy, subclinical atherosclerosis, and cardiovascular events - Implications for the use of preventive pharmacotherapy : MESA (Multi-Ethnic Study of Atherosclerosis). In: Journal of the American College of Cardiology. 2014 ; Vol. 63, No. 5. pp. 434-443.
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abstract = "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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AU - Bittencourt, Márcio Sommer

AU - Blaha, Michael J.

AU - Blankstein, Ron

AU - Budoff, Matthew

AU - Vargas, Jose D.

AU - Blumenthal, Roger S.

AU - Agatston, Arthur S.

AU - Nasir, Khurram

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N2 - 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.

AB - 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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