by Robbo on 21 June, 2009
Heart disease is the leading cause of death worldwide. What if there was one tablet that could reduce heart disease by 80%. Too good to be true?
The concept of the “polypill” was first published in 2003 when Wald and Law conducted a theoretical projection analysis of a single pill which contained six drugs. That polypill comprised of three anti-hypertensives at half dose (thiazide, beta blocker and ACE inhibitor), plus aspirin, a statin and folic acid. The predicted benefit from this analysis was an 88% reduction in ischaemic heart disease events and an 80% reduction in stroke.
A year earlier Yusuf had proposed a similar combination but without the catchy name: the predicted benefit of this four-drug combination was a 75% reduction of cumulative risk of CVD events when used for secondary prevention.
The complete RGH E-Bulletin can be downloaded here
Compare this article to the Kanyini Vascular Collaboration which also includes a polypill trial.
The Bulletin is a joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041
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The impact of statins in stroke risk in patients with a history of cerebrovascular disease had been recently evaluated in the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol) trial which was published in 2006. A total of 4731 patients with a stroke or TIA within one to six months were included, other inclusion criteria included LDL levels of 2.6 to 4.9 mmol/L, and absence of coronary heart disease. Patients were randomly assigned to atorvastatin 80mg or placebo and were followed up for a median of 4.9 years with a primary end point being the first nonfatal or fatal stroke.
The SPARCL trial has found that statins exert beneficial effects in reducing occurrence of overall stroke. When subtypes of strokes were analysed, statins were associated with a reduction of ischemic stroke but also a significant increase in haemorrhagic stroke risk. Similar results were observed in a subgroup of patients with a history of cerebrovascular disease in the Heart Protection Study in which the use of statins increased the occurrence of haemorrhagic stroke without an effect on overall stroke incidence.
The rest of the RGH E-Bulletin can be read here.
A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
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As of 1st June 2009 Premarin® (conjugated oestrogens) and Premia Continuous® (conjugated oestrogens plus medroxyprogesterone acetate) will no longer be available for subsidised supply through the Pharmaceutical Benefits Schedule (PBS) in Australia; however, both will continue to be available as a private prescription.
According to the manufacturer, the reason for this is due to increased costs associated with the manufacture of these two preparations.
The table below outlines oral oestrogen preparations (oestrogen as a sole ingredient) that are currently available in Australia and their approximate daily doses. Should patients be unable to obtain Premarin® or Premia Continuous® via a private prescription, the PBS eligibility of the various preparations is also listed.
To read the complete article download the small PDF here.
A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
If you like this post and what else you see on the blog please subscribe by RSS feed (the orange button) or by email. Visit my subscription page.
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From the newsletter:
Suboptimal inhaler technique is a major barrier to effectiveness of inhalation therapy. Many patients, particularly the elderly and the very young have difficulty correctly using currently available inhaler devices.
Consequently, there is ongoing research into the development of inhaler devices that are easy to use and provide improved lung deposition. The Respimat® Soft Mist inhaler is a novel, metered-dose device for delivery of inhaled drugs to patients with asthma and chronic obstructive pulmonary disease.
The Respimat® inhaler uses mechanical power from a spring rather than propellants to release a ‘Soft Mist’ which lasts longer and is slower moving than that emitted from a pressurised metered dose inhaler (MDI). As compared to the MDI, which initially releases particles of a relatively large diameter (15 to 20 μm), the Respimat® inhaler releases a high proportion of particles which are respirable (<5μm).
To continue reading the newsletter download it here
A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
If you like this post and what else you see on the blog please subscribe by RSS feed (the orange button) or by email. Visit my subscription page.
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