Global Impact of Fixed-Dose Combination Therapies on Cardiovascular Mortality and Events, 2023-2050: A Modeling Study.
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BACKGROUND: Uptake of drugs for primary and secondary prevention of cardiovascular disease is low in many countries. Single-pill combination (SPC) therapies consisting of a statin and 1 or more antihypertensive drugs, with or without aspirin, can reduce rates of fatal and nonfatal cardiovascular disease, but their use is currently limited. OBJECTIVES: The authors modeled the potential impact of widespread adoption of SPC therapies over 2023 to 2050. METHODS: We used state-transition and demographic modeling approaches to project ischemic heart disease- and stroke-related deaths and nonfatal events in 182 countries. We modeled the effects of programs to roll out primary and secondary prevention SPCs in 2 scenarios, compared to non-SPC (current) care: 1) targeted strategies to improve adherence and reduce therapeutic inertia among persons already in care; and 2) population-based strategies to provide SPC therapies to most persons at intermediate-to-high risk. We conducted sensitivity analyses around our assumptions on adoption, long-term adherence, and the effect of aspirin. RESULTS: Over 2023-2050, use of SPC therapies could prevent up to 29 million deaths and 51 million cases in the targeted scenario and up to 72 million deaths and 130 million cases in the population scenario. The greatest share of fatal and nonfatal events prevented would be in South and East Asia and the Pacific because of population size. SPC therapies could reduce all-cause premature mortality by 2.0% (targeted) to 3.2% (population), facilitating achievement of global health targets. CONCLUSIONS: SPC therapies could substantially accelerate progress on cardiovascular disease mortality by increasing use of preventive drugs, especially in settings where uptake is currently low.
