The modifiable cardiovascular risk factors for patients are hypertension, hyperlipidemia, diabetes, and obesity. These have all significantly increased so that by the year 2020, they will account for 80% of all cardiovascular deaths worldwide. Patients over the age of 50 are at the greatest risk and should therefore, as many studies suggest, be treated for the prevention of cardiovascular disease, for both genders.
The studies began in 2003, and subsequently there have been 5 major studies initiated using multiple combinations of a statin, aspirin, diuretic, beta blocker, and an ACE inhibitor. The studies have used Lipitor 10mg or Zocor 40mg a day, folic acid 0.8mg daily, aspirin 81mg daily, 12.5mg HCTZ, atenolol 50mg daily, ACE inhibitor Altace 2.5mg daily, and Losartan 50mg daily. Blood pressure reductions were as little as 7/6 to as great as 18/10. The LDL reductions ranged from 20 to 70 and the projected cardiovascular risk reduction in the 5 studies were 86%, 62%, 34%, 60%, and 72%. The decrease in the stroke risk was 74%, 48%, 21%, 50%, and 64%.
Furthermore, some studies have demonstrated that patients with a calcium score of greater than 100 benefit the most. This resulted in a 64% reduction in the number of unnecessary prescriptions. Dr. Jamnadas has made the following recommendations:
- Patients over the age of 50 with multiple risk factors with subclinical evidence of cardiovascular disease such as increased carotid intimal thickness, coronary calcium with a score greater than 100, peripheral vascular disease, diabetes, hypertension and hyperlipidemia, and metabolic syndrome, should be considered as high risk and be considered good candidates for a prevention program with a poly-pill. Patients with a very strong family history who have at least 2 other risk factors noted above are also good candidates for a prevention protocol.
- The medications can be initially given individually. Furthermore, the use of nebivolol may be beneficial because of its lack of metabolic effects, but taken at a low dose. Dr. Jamnadas is planning to combine these medications into a single poly-pill.
Dr. Jamnadas intends to create many combinations of poly-pills to suit the individual patient. Some examples include:
- #Aspirin 81 mg, Crestor 5 mg, folic acid 0.8 mg, Vasotec 5 mg, HCTZ 6.25 mg, atenolol 12.5 mg
- #Aspirin 81 mg, Lipitor 10 mg, folic acid 0.8 mg, Vasotec 5 mg, HCTZ 6.25 mg, atenolol 25 mg
- #Aspirin 81 mg, Lipitor 10 mg, folic acid 0.8 mg, Losartan 25mg, HCTZ 6.25 mg, atenolol 25 mg
All patient should be monitored for side effects.