Randomized Polypill Crossover Trial in People Aged 50 and Over 英文参考文献.docVIP

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Randomized Polypill Crossover Trial in People Aged 50 and Over 英文参考文献.doc

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Randomized Polypill Crossover Trial in People Aged 50 and Over 英文参考文献

RandomizedPolypillCrossoverTrialinPeopleAged50 andOver DavidS.Wald,JoanK.Morris,NicholasJ.Wald* WolfsonInstituteofPreventiveMedicine,BartsandtheLondonSchoolofMedicineandDentistry,QueenMaryUniversityofLondon,London,UnitedKingdom Abstract Background:APolypillisproposedfortheprimarypreventionofcardiovasculardiseaseinpeoplejudgedtobeatriskon accountoftheiragealone.Itsefficacyinreducingcholesterolandbloodpressureisuncertain. Methods:Weconductedarandomizeddouble-blindplacebo-controlledcrossovertrialofaPolypillamongindividualsaged 50+ without a history of cardiovascular disease and compared the reductions with those predicted from published estimates of the effects of the individual drugs. Participants took the Polypill (amlodipine 2.5mg, losartan 25mg, hydrochlorothiazide12.5mgandsimvastatin40mg)eacheveningfor12weeksandaplaceboeacheveningfor12weeks inrandomsequence.Themeanwithin-persondifferencesinbloodpressureandlowdensitylipoprotein(LDL)cholesterolat theendofeach12weekperiodweredetermined. Results:84outof86participants completedbothtreatmentperiods.Themeansystolicbloodpressure wasreducedby 17.9mmHg(95%CI,15.7–20.1)onthePolypill,diastolicbloodpressureby9.8mmHg(8.1–11.5),andLDLcholesterolby 1.4mmol/L(1.2–1.6),reductionsof12%,11%,and39%respectively.Theresultswerealmostidenticaltothosepredicted; 18.4mmHg,9.7mmHg,and1.4mmol/Lrespectively. Conclusion:ThePolypillresultedinthepredictedreductionsinbloodpressureandLDLcholesterol.Longtermreductions ofthismagnitudewouldhaveasubstantialeffectinpreventingheartattacksandstrokes. TrialRegistration:Controlled-TISRCTCitation: Wald DS, Morris JK, Wald NJ (2012) Randomized Polypill Crossover Trial in People Aged 50 and Over. PLoS ONE 7(7): e41297. doi:10.1371/ journal.pone.0041297 Editor:JamesM.Wright,UniversityofBritishColumbia,Canada ReceivedApril24,2012;AcceptedJune19,2012;PublishedJuly18,2012 Copyright: ? 2012 Wald et al. This is an open-access article distributed under the terms of the Creative Commons Attribution L