Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Putting evidence into practice
Slide content:Systematic Reviews of Treatment of Cardiac Risk Factors A series of meta-analyses found benefits for lowering cholesterol (Law, Wald, & Rudnicka , 2003), blood pressure (Law, Wald, Morris, & Jordan, 2003), and homocysteine (Wald, Law, & Morris, 2002) Led to proposal for development of a polypill (six medications: statin, three blood pressurelowering drugs in half standard dose, beta blocker, folic acid, and aspirin) that could potentially reduce cardiovascular disease by 80% (Wald & Law, 2003; Wald, 2012; Yusuf, 2012) Though a polymeal may be natural, safer, and tastier, with wine, fish, dark chocolate, fruits and vegetables, garlic, and almonds (Franco, et al., 2004) Initial clinical trial in India found lowering of blood pressure and cholesterol. Subsequent study confirmed the findings. (Yusuf et al., 2009; Yusuf, 2012) 8
Slide notes:8 Lets look at some examples of systematic reviews, in particular, systematic reviews of the treatment of cardiac risk factors. A group of meta-analyses published in the early part of the last decade found benefits for lowering cholesterol or homocysteine [hoh-moh- sis -tuh-een] levels, either with statin [ stat -n] drugs or with other types of drugs or with other interventions such as diet... The combined publication of these meta-analyses led to a proposal for developing a so-called polypill [ pawl- ih-pill] that would contain six medications: a statin, three blood pressurelowering drugs in half their standard dose, a beta-blocker, folic acid, and aspirin. The authors argued that such a pill could potentially reduce cardiovascular disease in western countries by eighty percent. There was disagreement that giving everyone this pill would have this beneficial an outcome. Many argued that the polypill would need to be subjected to a randomized controlled trial. There was much correspondence in the British Medical Journal and elsewhere about the polypill. A different suggestion was the notion of a poly-meal that would be natural and safe as well as tasty and would give people appropriate portions of wine, fish, dark chocolate, fruits and vegetables, garlic, and almonds. The polypill has actually been developed and is undergoing initial clinical trials in India. The initial trial was in 2009 and showed favorable results at the time; a subsequent study in 2012 has shown that this pill does lower blood pressure and cholesterol beneficially.