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Prevention of Cardiovascular Disease in Middle-aged and Elderly Iranians Using a Single PolyPill (PolyIran)

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ClinicalTrials.gov Identifier: NCT01271985
Recruitment Status : Completed
First Posted : January 7, 2011
Last Update Posted : January 22, 2019
Sponsor:
Collaborators:
Golestan University of Medical Science
University of Birmingham
Information provided by (Responsible Party):
Tehran University of Medical Sciences

Study Description
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Brief Summary:
The purpose of this study is to determine the effects of PolyPill tablet (a fixed dose combination of two anti-hypertensive medications, atorvastatin and aspirin) on primary and secondary prevention of cardiovascular disease in Iranian adults older than 50.

Condition or disease Intervention/treatment Phase
Cardiovascular Diseases Drug: PolyPill Other: Minimal care Phase 3

Detailed Description:

Cardiovascular diseases (myocardial infarction and stroke) are the most common cause of death and disability in Iran and account for nearly half of all-cause mortality in Iranians. Therefore, prevention of cardiovascular diseases is a top priority in countries with limited health system budgets such as Iran.

Eighty seven to hundred percent of patients dying from Coronary Heart Disease (CHD) have at least one risk factor for cardiovascular diseases. Therefore, risk factor modification in middle-aged and old individuals might prevent death and is a main priority. Combination drug therapy has been proposed as a cost-effective measure to reduce modifiable risk factors for cardiovascular disease in aged people. It has been showed that combination drug therapy can potentially decrease ischemic heart events and strokes by 88 and 80 percent, respectively.

The purpose of this study is to determine the effects of PolyPill tablet (a fixed dose combination of two anti-hypertensive medications, atorvastatin and aspirin) on primary and secondary prevention of cardiovascular disease in Iranian adults older than 50.

This is a study on subjects older than 50 enrolled in the Golestan Cohort Study. The study is designed as a pragmatic cluster randomized trial. The study comprises three arms as follows:

  1. 4234 randomly selected participants receive PolyPill tablets once daily and Minimal care (which consists of direct education and pamphlet on cardiovascular risk reduction, biannual follow-ups and BP measurements).
  2. 4177 randomly selected participants receive only Minimal care as described above.
  3. Include remaining 24000 participants of rural participants of Golestan cohort, aged 50 and higher who receive the basic primary health care provided by the local physicians and Community Health Workers for the whole participants of Golestan Cohort study consistent with the current Iranian Health Care System guidelines. A random sample of 4395 subjects from this usual care arm were selected from this group as the third arm of the study and outcome ascertainment will be performed for this sample and will be used in the secondary comparison.

Arms #1 and #2 are compared via a 2-armed open-labeled cluster Randomized Controlled Trial. Comparisons between arm #3 and the other 2 arms are also performed.

Endpoints include major cardiovascular events (death and hospitalization)

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 8410 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: Fixed-dose Combination Therapy (PolyPill) in Primary and Secondary Prevention of Cardiovascular Disease in Middle-aged and Elderly Iranians
Actual Study Start Date : February 2011
Actual Primary Completion Date : January 2019
Actual Study Completion Date : January 2019
Arms and Interventions
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Arm Intervention/treatment
Active Comparator: PolyPill
PolyPill once daily and Minimal Care
 Drug: PolyPill
A combination tablet containing Aspirin 81 mg, enalapril 5 mg (or valsartan 40 mg), atorvastatin 20 mg and hydrochlorothiazide 12.5 mg taken once daily
Other Names:
  • PolyPill 4-1
  • PolyPill 4-2

Other: Minimal care
Health education pamphlet on reducing cardiovascular risk factors, direct education on reducing cardiovascular risk factors provided by the study physician and the Community Health Worker, biannual follow-up and BP measurement
Active Comparator: Minimal care
Minimal care.
 Other: Minimal care
Health education pamphlet on reducing cardiovascular risk factors, direct education on reducing cardiovascular risk factors provided by the study physician and the Community Health Worker, biannual follow-up and BP measurement
No Intervention: Usual care
Basic primary health care provided by the local physicians and Community Health Workers consistent with the current Iranian Health Care System guidelines.


Outcome Measures
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Primary Outcome Measures :
  1. Time to first major cardiovascular event [ Time Frame: 5 years ]

    Major cardiovascular events are defined as:

    1. Major coronary events include: sudden cardiac death, myocardial infarction, a diagnosis of angina, revascularization procedure
    2. Cerebrovascular accidents (CVA) including transient ischemic attacks (TIA)
    3. Hospitalization because of cardiovascular disease


Secondary Outcome Measures :
  1. Blood pressure [ Time Frame: 5 years ]
    Changes in blood pressure after 5 years

  2. Fasting blood sugar, total cholesterol, HDL-C and LDL-C [ Time Frame: 5 years ]
    Changes in fasting blood sugar and lipid profile after 5 years

  3. Number of Subjects Developing Adverse Events [ Time Frame: 5 years ]
    Number of participants who experience adverse effects to the PolyPill tablet leading to discontinuation.

  4. Compliance [ Time Frame: 5 years ]
    Compliance is measured by pill-count in participants of the intervention arm as percent pills taken.

  5. Rate of major cardiovascular events [ Time Frame: 5 years ]
    Number of major cardiovascular events (as described above) during 5 years


Eligibility Criteria
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Ages Eligible for Study:   50 Years to 79 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • 50-79 years old
  • Enrollment in the Golestan Cohort Study

Exclusion Criteria:

  1. Hypersensitivity to any of PolyPill components:

    1. Hypersensitivity to Non-steroidal anti-inflammatory agents
    2. Hypersensitivity to statins
    3. Hypersensitivity to hydrochlorothiazide or sulfonamides
    4. Hypersensitivity to enalapril and valsartan
  2. Past medical history of angioedema
  3. Medical history of GI bleeding or peptic ulcer in the last 3 months
  4. Pregnancy or lactation
  5. Bleeding disorders such as hemophilia
  6. Receiving anticoagulation therapy
  7. Alcohol consumption greater than 40gr/week
  8. Advanced liver disease
  9. Uncontrolled seizures

  10. Asthma with any of the following criteria present:

    1. Daily symptoms
    2. Asthmatic attacks waking the patient from sleep more than once a week
    3. History of nasal polyps
    4. Aspirin sensitive asthma
    5. Presence of rhinitis symptoms not due to infection
  11. Past medical history of gout
  12. Serum creatinine values above 2 mg/dL or a Glomerular Filtration Rate (GFR) below 30 mL/min
  13. Hemoglobin concentrations below 11 g/dL for males and 10 g/dL for females
  14. BP < 90/60
  15. Debilitating medical/mental disorders affecting medication compliance (including psychosis, disabilities, and blindness)
  16. Past medical history of stroke
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01271985


Locations
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Iran, Islamic Republic of
Golestan Cohort Study Center
Gonbad, Golestan, Iran, Islamic Republic of
Sponsors and Collaborators
Tehran University of Medical Sciences
Golestan University of Medical Science
University of Birmingham
Investigators
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Study Chair: Reza Malekzadeh, M.D. Digestive Disease Research Center
More Information
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Publications:

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Tehran University of Medical Sciences
ClinicalTrials.gov Identifier: NCT01271985    
Other Study ID Numbers: DDRC.89.17
First Posted: January 7, 2011    Key Record Dates
Last Update Posted: January 22, 2019
Last Verified: January 2019
Keywords provided by Tehran University of Medical Sciences:
Cardiovascular Diseases
Drug Combinations
prevention and control
 Aspirin
Antihypertensive Agents
Antilipemic Agents
Additional relevant MeSH terms:
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Cardiovascular Diseases