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Khan AA, Siddiqui SA, Yasmin F, Abidi SM, Tariq R, Ahmed H, Murtaza N, Jawed F, Lashkerwala SS, Moin A, Shah SMI, Ullah I, Yousaf Z, Faizan M, Shahid MH. The Era of Polypills in the Management of Cardiovascular Diseases: Are We There Yet? Curr Probl Cardiol 2022:101233. [PMID: 35490770 DOI: 10.1016/j.cpcardiol.2022.101233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/24/2022] [Indexed: 11/03/2022]
Abstract
Cardiovascular Diseases (CVD) are the leading cause of mortality globally. Wald and Law proposed the idea of a 'polypill'; a fixed dose combination therapy (FDC) in the form of a single pill to curb the CVD epidemic. Such a drug would include the combination of a broad spectrum of drugs including cholesterol lowering drugs, antihypertensive drugs, anti-platelet drugs, anti-coagulation drugs, anti-arrhythmic drugs, which are frequently integrated to combat specific CVDs. This 'polypill' holds the potential to pose several advantages like increased compliance, improved quality of life, risk factor control, psychological relief, and cost effectiveness along with minimal side effects. Several trials (like TIPS, UMPIRE, PolyIran etc.) have tested different treatment strategies to test the hypothesis of Wald and Law. Unlike the past physicians are now highly aware of this new strategy.The future of polypill in the management of CVD lies in a strategy where polypills are treated supplementary to the already existing preventive care, which includes lifestyle modifications and efforts to reduce tobacco use.
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Affiliation(s)
- Arsalan Aamir Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Farah Yasmin
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Rabbia Tariq
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Hiba Ahmed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Noor Murtaza
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Fareeha Jawed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Ariba Moin
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Irfan Ullah
- Department of Internal Medicine, Kabir Medical College, Gandhara University, Peshawar, Pakistan.
| | - Zohaib Yousaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Muhammad Faizan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
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Perrone-Filardi P, Minghetti P, Menditto E, Bianchi S, Scaglione F, Trifirò G, Piccinocchi G, Corona T, Gambarelli G, Izzi C, Misciagna V, Putignano D, Lopatriello S, Cafiero D. The value of the polypill in cardiovascular disease: an Italian multidisciplinary Delphi panel consensus. J Cardiovasc Med (Hagerstown) 2021; 22:246-258. [PMID: 33633039 DOI: 10.2459/jcm.0000000000001159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The purpose of this work was to reach the consensus of a multidisciplinary and multistakeholder Italian panel on the value of polypill in cardiovascular disease, with respect to the clinical, technological, economic and organizational dimension. A three-step modified Delphi method was used to establish consensus. Eleven experts in the area of cardiology, pharmaceutical technology, general practice, hospital pharmacy, pharmacology, and health economics participated in the expert panel. To identify existing evidence concerning the value of polypill in the prevention of patients with cardiovascular disease, a systematic literature review was carried out according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement guidelines. In the first round, 22 statements were distributed to the panel. Panel members were asked to mark 'agree' or 'disagree' for each statement and provide any comments. The same voting method was again used for the second round. In the first round nine statements met consensus. In the second round, 10 statements reached consensus. Overall, consensus was reached for 19 statements representing five value polypill domains: clinical, technological, economic and organizational. During a final web meeting with all panel members consensus document open points were discussed. Panel members agreed to recognize polypill as effective in reducing cardiovascular events, blood pressure and lipids, cardiovascular risk and the weight of therapy, in therapeutic adherence improvement, in the absence of differences in bioavailability between drugs administered in fixed or free combinations and the better cost-effectiveness profile compared with standard care. This document represents a knowledge framework to inform decision makers of the value of polypill in cardiovascular prevention.
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Affiliation(s)
- Pasquale Perrone-Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples
- Mediterranea Cardiocentro, Napoli
| | - Paola Minghetti
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Milano
| | - Enrica Menditto
- Department of Pharmacy, CIRFF, Centre of Pharmacoeconomics, University of Naples Federico II, Napoli
| | - Stefano Bianchi
- U.O. Assistenza Farmaceutica Ospedaliera, Territoriale e Ricerca clinica, Ferrara
| | - Francesco Scaglione
- Department of Oncology and Hemato-oncology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan
- Clinical Pharmacology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina
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Zhao C, Li S, Zhang J, Huang Y, Zhang L, Zhao F, Du X, Hou J, Zhang T, Shi C, Wang P, Huo R, Woodman OL, Qin CX, Xu H, Huang L. Current state and future perspective of cardiovascular medicines derived from natural products. Pharmacol Ther 2020; 216:107698. [PMID: 33039419 DOI: 10.1016/j.pharmthera.2020.107698] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023]
Abstract
The contribution of natural products (NPs) to cardiovascular medicine has been extensively documented, and many have been used for centuries. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Over the past 40 years, approximately 50% of newly developed cardiovascular drugs were based on NPs, suggesting that NPs provide essential skeletal structures for the discovery of novel medicines. After a period of lower productivity since the 1990s, NPs have recently regained scientific and commercial attention, leveraging the wealth of knowledge provided by multi-omics, combinatorial biosynthesis, synthetic biology, integrative pharmacology, analytical and computational technologies. In addition, as a crucial part of complementary and alternative medicine, Traditional Chinese Medicine has increasingly drawn attention as an important source of NPs for cardiovascular drug discovery. Given their structural diversity and biological activity NPs are one of the most valuable sources of drugs and drug leads. In this review, we briefly described the characteristics and classification of NPs in CVDs. Then, we provide an up to date summary on the therapeutic potential and the underlying mechanisms of action of NPs in CVDs, and the current view and future prospect of developing safer and more effective cardiovascular drugs based on NPs.
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Affiliation(s)
- Chunhui Zhao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Sen Li
- National Resource Center for Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China; College of Chinese Medicinal Materials, Jilin Agricultural University, Changchun 130118, China
| | - Junhong Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yuanyun Huang
- Biology Department, Cornell University, Ithaca, NY 14850, United States of America
| | - Luoqi Zhang
- National Resource Center for Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China; College of Chinese Medicinal Materials, Jilin Agricultural University, Changchun 130118, China
| | - Feng Zhao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Xia Du
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China; Shaanxi Academy of Traditional Chinese Medicine, Xi'an 710003, China
| | - Jinli Hou
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Tong Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Chenjing Shi
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Ping Wang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Ruili Huo
- China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Owen L Woodman
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC 3800, Australia
| | - Cheng Xue Qin
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC 3800, Australia; School of Pharmaceutical Science, Shandong University, Shandong 250100, China; Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong 250100, China.
| | - Haiyu Xu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Luqi Huang
- National Resource Center for Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China; China Academy of Chinese Medical Sciences, Beijing 100700, China.
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Gómez-Álvarez E, Verdejo J, Ocampo S, Ruiz E, Martinez-Rios MA. Reaching blood pressure guideline targets with the CNIC polypill in patients with a previous cardiovascular event in Mexico: a post hoc analysis of the SORS study. Future Cardiol 2019; 16:53-60. [PMID: 31850802 DOI: 10.2217/fca-2019-0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To determine the effectiveness of Centro Nacional de Investigaciones Cardiovasculares (CNIC)-polypill (acetylsalicylic acid 100 mg, ramipril 5/10 mg, simvastatin 40 mg) in achieving blood pressure (BP) goals. Patients & methods: A multicenter, observational, one cohort, prospective study. BP targets were analyzed in patients with cardiovascular disease after 12-months treatment with the CNIC polypill. Results: A total of 572 patients (59.4 ± 13.9 years, 57.3% men) were analyzed. At baseline, BP was 147.1 ± 18.1/88.3 ± 10.6 mmHg, 97.1% of patients were taken renin-angiotensin system inhibitors, 5.4% calcium antagonists, 1.9% diuretics and 13.1% β-blockers. The proportion of patients who achieved BP targets increased from 20.1 to 55.4% (p < 0.001). Conclusion: In routine practice, switching from usual care to the CNIC-polypill in patients with cardiovascular disease could facilitate achieving BP goals.
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Affiliation(s)
| | - Juan Verdejo
- Instituto de Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | | | - Emilio Ruiz
- Medical Affairs Department, Ferrer Internacional, Barcelona, Spain
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González Mendia O, Blanco ME, Rico E, Alonso ML, Maguregui MI, Alonso RM. Efficient Method Development and Validation for the Determination of Cardiovascular Drugs in Human Plasma by SPE–UHPLC–PDA–FLD. Chromatographia 2017. [DOI: 10.1007/s10337-017-3274-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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The polypill approach - An innovative strategy to improve cardiovascular health in Europe. BMC Pharmacol Toxicol 2017; 18:10. [PMID: 28166827 PMCID: PMC5294740 DOI: 10.1186/s40360-016-0102-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/27/2016] [Indexed: 12/21/2022] Open
Abstract
Background Cardiovascular disease (CVD) is a major cause of disability and premature death. Despite European guidelines advocating the use of medical therapies in CVD, many patients still do not achieve the guideline-recommended treatment, which highlights the need for change and innovations in this field. This requirement has been widely recognised by the national ministries of health, several European cardiology societies, and the European Parliament, who support the initiation of strategies to improve and promote cardiovascular health. Discussion One of the key risk factors to recurrent cardiovascular events is the lack of adherence to medication and this has been added to the agenda of the European Commission. With the intention to improve treatment adherence in CVD, polypills have been investigated and numerous studies demonstrate that they significantly improve medication adherence, which contributes to the improvement of health outcomes. In Europe, the first cardiovascular polypill, developed by a public-private partnership (CNIC-Ferrer), recently became available for general prescription as a therapy for CVD prevention. This polypill significantly improves adherence, preventing fatal and non-fatal cardiovascular events, and appears to be a cost-effective strategy to improve sustainability of the health care systems in CVD. Conclusions Given the importance of urgent and simple solutions to restraining the pandemic nature of CVD, the polypill approach should therefore be considered by physicians and public health systems as an available and innovative option to improve cardiovascular health.
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