The physiological paradox: reframing the polypill as a vaccine for cardiovascular disease

Association between population mean and distribution of deviance in demographic surveys from 65 countries: cross sectional study

OBJECTIVES

To examine whether conditions related to scarcity at the left side of the distribution (anaemia, severe chronic energy deficiency, and underweight) are as strongly related to population means as conditions of excess at the right side of the distribution (overweight and obesity).

DESIGN

Observational study.

SETTING

65 countries, with nationally representative cross sectional data from 1994 to 2014 obtained from the Demographic Health Surveys.

PARTICIPANTS

Non-pregnant women aged 20-49. Sample of 65 countries and n=524 380 for analysis of BMI; sample of 44 countries and n=316 465 for analysis of haemoglobin.

MAIN OUTCOME MEASURES

The association between mean and prevalence of each category. For BMI, prevalence of severe chronic energy deficiency (SCED, BMI <16.0), underweight (BMI <18.5), overweight (BMI >25) and obese (BMI >30.) were measured; for haemoglobin, prevalence of anaemia (haemoglobin <12.0 g/dL) and severe anaemia (haemoglobin <8.0 g/dL) were examined.

RESULTS

There was a strong association between mean BMI and prevalence of overweight (r²=0.98; r=0.99; β=8.3 (8.0 to 8.6)) and obesity (r²=0.93; r=0.97; β=4.2 (3.9 to 4.5)). For left sided conditions, a moderate to strong association was found between mean BMI and prevalence of underweight (r²=0.67; r=-0.82; β=-2.7 (-3.1 to -2.2)), and a weaker association for SCED (r²=0.38; r=-0.61; β=-0.32 (-0.43 to -0.22)). There was a moderate association between mean haemoglobin and prevalence of anaemia (r²=0.46; r=-0.68; β=-10.8 (-14.5 to -7.1)) and a weaker association with severe anaemia (r²=0.30; r=-0.55; β=-0.55 (-0.81 to -0.29)).

CONCLUSIONS

The associations between population means and prevalence of conditions of scarcity such as low BMI and anaemia were substantially weaker than the associations of mean BMI with conditions of excesses such as overweight and obesity.

PA32540 for the secondary prevention of cardiovascular disease in patients at risk for aspirin-associated gastric ulcers

Prescribed in patients with a history of myocardial infarction, stroke, transient ischemic attack, coronary intervention or bypass surgery, aspirin is one of the medications most commonly used in the secondary prevention of cardiovascular diseases. It has become a mainstay of therapy after years of solid evidence supporting its efficacy in clinical trials. However, a number of risks and side effects accompany its benefits, including the notable risk of bleeding and gastrointestinal side effects. Numerous mechanisms have been proposed to attenuate these effects to promote adherence and to expand the population for which aspirin is a reasonable treatment option. A polypill or combination formulation that includes a proton pump inhibitor, a drug commonly prescribed alongside aspirin, is one potential avenue of therapy. One such combination pill, PA32540, has undergone Phase I and Phase III trials and shows promising safety and efficacy results in these preliminary trials.