Prevention of Cardiovascular Disease With Polypill Among Pars Cohort Participants

Tehran University of Medical Sciences4,415 enrolled

Overview

The purpose of this study is to determine the effects of a fixed dose combination of enalapril (or valsartan), with hydrochlorthiazide, atorvastatin and acetylsalicylic acid (PolyPill) on primary and secondary prevention of cardiovascular disease in participants of Pars Cohort of Iran.

Cardiovascular diseases (CVDs) are the most common causes of death and disability in Iran and account for nearly half of all-cause mortality in Iranians. Therefore, prevention of cardiovascular diseases is a top priority in countries with limited health system budgets such as Iran. Eighty seven to hundred percent of patients dying from CVDs have at least one risk factor for cardiovascular diseases. Therefore, risk factor modification might prevent death and is a main priority. Combination drug therapy has been proposed as a cost-effective measure to reduce modifiable risk factors for cardiovascular disease. It has been showed that combination drug therapy can potentially decrease ischemic heart events and strokes by 88 and 80 percent, respectively. The study is designed as a pragmatic cluster randomized controlled trial. The purpose of this study is to determine the effects of a fixed dose combination of either enalapril or valsartan, with hydrochlorthiazide, atorvastatin and acetylsalicylic acid (PolyPill) on primary and secondary prevention of cardiovascular disease in Iranian adults older than 50. Two formulations of Polypill tablets were used. The first formulation (Polypill-E) contained enalapril 5 mg. If participants developed cough, they were switched by a trained physician to Polypill-V, containing valsartan 40 mg instead of enalapril. The investigators have previously tested the same combination in a different setting in Golestan, Northeast of Iran. The results of the study were published in the Lancet. The current study enrolls participants of Pars Cohort running in Fars province, southern Iran, aged above 50. A total of 4415 participants (91 clusters) were recruited following inclusion and exclusion criteria. The study comprises two arms as follows: 2200 randomly selected participants receive PolyPill tablets once daily and minimal care (which consists of direct education and pamphlet on cardiovascular risk reduction). 2215 randomly selected participants receive only minimal care as described above. Endpoints include major cardiovascular events (MCVE).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Enrollment

4,415

Conditions

Cardiovascular Diseases

Interventions

PolyPillDRUG

After the baseline enrollment and excluding non-eligible participants, we randomized villages to Polypill and control arms. Follow-ups are scheduled for 1, 3, and 6 months after the initial enrollment in the Polypill arm and every six months thereafter. For the minimal care arm, the follow-ups are arranged every six months.

Eligibility

Sex: ALLMin age: 50 YearsMax age: 79 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 50-79 years old * Enrollment in the Pars Cohort Study Exclusion Criteria: 1. Not consenting to participate in the study 2. Hypersensitivity to any of PolyPill components: 1. Hypersensitivity to Non-steroidal anti-inflammatory agents 2. Hypersensitivity to statins 3. Hypersensitivity to hydrochlorothiazide or sulfonamides 4. Hypersensitivity to enalapril and valsartan 3. Past medical history of angioedema 4. Medical history of GI bleeding or peptic ulcer in the last 3 months 5. Pregnancy or lactation 6. Bleeding disorders such as hemophilia 7. Receiving regular anticoagulation therapy 8. Alcohol consumption greater than 40gr/week 9. Advanced liver disease 10. Uncontrolled seizures 11. Asthma with any of the following criteria present: 1. Daily symptoms 2. Asthmatic attacks waking the patient from sleep more than once a week 3. History of nasal polyps 4. Aspirin sensitive asthma 5. Presence of rhinitis symptoms not due to infection 12. Past medical history of gout 13. Serum creatinine values above 2 mg/dL 14. Glomerular Filtration Rate (GFR) below 30 mL/min 15. Hemoglobin concentrations below 11 g/dL for males and 10 g/dL for females 16. BP \< 90/60 mmHg 17. Debilitating medical/mental disorders affecting compliance (including psychosis, disabilities, and blindness) 18. Past medical history of stroke

Locations (1)

Pars Cohort Center

Shiraz, Fars, Iran

Outcomes

Primary Outcomes

Major Cardiovascular Events (MCVE)

the first occurrence of acute coronary syndrome (non-fatal myocardial infarction and unstable angina), fatal myocardial infarction, sudden cardiac death, new-onset heart failure, coronary artery revascularization procedures, transient ischemic attack, cerebrovascular accidents (fatal or non-fatal), and hospitalization due to any of the mentioned conditions.

Time frame: 5 years

Secondary Outcomes

Number of Subjects Developing Adverse Events

Number of participants who experience adverse effects to the PolyPill tablet leading to discontinuation

Time frame: 5 years

Compliance

Compliance is measured by pill-count in participants of the intervention arm as percent pills taken

Time frame: 5 years

Non cardiovascular mortality

Any death other than those due to CVDs during 5 years

Time frame: 5 years

Level of fasting blood sugar (mg/dL)

Changes in fasting blood sugar after 5 years

Time frame: 5 years

Level of blood pressure (mmHg)

Changes in blood pressure after 5 years

Time frame: 5 years

Level of total cholesterol (mg/dL)

Changes in total cholesterol after 5 years

Time frame: 5 years

Level of HDL (mg/dL)

Changes in HDL after 5 years

Data from ClinicalTrials.gov

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