CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 4, July/August 2010
AFRICA
243
Amlodipine + atorvastatin single pill is the most effective choice
for primary prevention
Preventing cardiovascular events in at-risk
patients is greatly enhanced if a single pill
is prescribed for the commonly occurring
risks of hypertension and dyslipidaemia.
In this new study using data from a
commercially managed healthcare organi-
sation in the United States, only one in
five patients adhered to and took their
preventative tablets as medication for
dyslipidaemia and hypertension if they
were taken as two individual tablets. If
the medication was given as a single
tablet, in this case atorvastatin plus
amlodipine, adherence improved to one
in two patients.
This 150% increase in compliance
is very significant and applies to every-
day clinical practice, compared to lower
compliance differences between single
pills and two or more pills, which was
found in specially designed compliance
studies.
The overall benefit in terms of the
reduction in cardiovascular events is
substantiated in this study, which showed
similar low rates (1.88 per 100 person-
years) for patients who were adherent
to their medication (whether one pill or
two), compared to 2.47 events per 100
person-years in non-adherent patients.
In essence, if the single pill increases
compliance two-fold and compliance
reduces events by 30% compared to non-
compliance, the role of the single pill in
primary prevention is the most effective
choice for commercially managed health-
care funds.
The evaluation of the US commercial-
ly managed healthcare system included
patients with hypertension and dyslipi-
daemia but without diabetes, and evalu-
ated the cardiovascular events in adherent
patients in categories of either two pills
or the single-pill calcium channel blocker
(SPAA) and a statin.
The primary outcome measure was the
rate of cardiovascular events occurring
in the six- to 18-month period following
the index date, set as the date when the
patient was started on either the SPAA or
the two-drug, two-pill regimen. Patients
who had a cardiovascular event in the
preceding six months were excluded from
the analysis.
Adherence levels were much higher
for the single-pill approach (Table 1).
Importantly, the reduction in cardio-
vascular events in adherent patients was
the same regardless of whether patients
were on a single- or two-pill treatment
regimen.
J Aalbers, Special Assignments Editor
1. Chapman RH, Yeaw J, Roberts CS.
Association between adherence to calcium-
channel blocker and statin medications and
likelihood of cardiovascular events among US
managed care enrolees. BMMC
Cardiovasc
Disorders
2010, 10:29 doi:10.1186/1471-
2261-10-29.
TABLE 1. ADHERENCE MEASURES FOR SPAAAND CCB
+
STATIN (TWO PILLS) IN
PRIMARY-PREVENTION PATIENTS
SPAA
(
n
=
1 537)
CCB
+
statin
(
n
=
17 910)
p
-value
Six months
Number (%) of patients with PDC
≥
80% 868 56.5% 3 825 21.4%
<
0.001
Mean PDC (SD)
0.73 (0.26)
0.49 (0.31)
Median PDC
0.83
0.50
<
0.001
12 months
Number (%) of patients with PDC
≥
80% 712 46.3% 3 529 19.7%
<
0.001
Mean PDC (SD)
0.66 (0.30)
0.46 (0.31)
Median PDC
0.75
0.46
<
0.001
18 months
Number (%) of patients with PDC
≥
80% 650 42.3% 3 342 18.7%
<
0.001
Mean PDC (SD)
0.62 (0.31)
0.43 (0.32)
Median PDC
0.72
0.42
<
0.001
TABLE 2. CARDIOVASCULAR EVENTS FROM SIX MONTHS FOLLOWING
INITIATION OF SPAA OR CCB
+
STATIN IN PRIMARY-PREVENTION PATIENTS
Overall
(
n
=
19 447)
Adherent
(
n
=
4 693)
Non-
adherent
(
n
=
14 754)
SPAA
(
n
=
1 537)
CCB
+
statin
(
n
=
17 910)
12-month event rate
Total events (
n
)
452
88
364
19
433
Total person-years
19 447 4 693 14 754 1 537
17 910
Incidence rate per 100 person-years
2.32
1.88
2.47
1.24
2.42
Overall event rate
Total events (
n
)
818
164
654
38
780
Total person-years
38 074 9 139 28 935 2 734
35 340
Incidence rate per 100 person-years
2.15
1.79
2.26
1.39
2.21
It's the
shell that
makes
safer.
R
Safety-Coated
R
81mg
The ORIGINAL low dose aspirin
for optimum cardio-protection
Hp
Each tablet contains Aspirin 81mg. Reg.No.: 29/2.7/0767
Pharmafrica (Pty) Ltd, 33 Hulbert Road, New Centre, Johannesburg 2001
Under licence from Goldshield Pharmaceuticals Ltd. U.K.
