Requirement of pharmacological treatment for primary prevention of cardiovascular disease in asymptomatic office-executives in north-India.

Background: Recently, a concept of multi-drug treatment of all individuals in the form of a polypill, irrespective of their risk factor profile, has been proposed with a view to provide an effective means for prevention of cardiovascular disease (CVD). While the rationale, benefits and ethicality of such an approach continue to remain a matter ofdebate, it is not known what proportion of asymptomatic adult population does actually require pharmacological therapy for primary prevention of CVD according to the existing guidelines.
Methods: 1927 consecutive office executives, free of any CVD, undergoing routine health check-up at a tertiary care centre in North-India during the year 2005 were included in the study. For all subjects, information was collected based on their case-records comprising of comprehensive clinical evaluation and the results of biochemical investigations. Requirement of treatment with three anti-atherosclerotic drugs- aspirin, statin and an anti-hypertensive agent was estimated as per the current guidelines.
Results: Mean age of the subjects was 45.2 +/- 10.3 years and 71.6% were males. Diabetes was present in 14.3%, hypertension in 46.3% and dyslipidemia in 76.0%. Metabolic syndrome was diagnosed in 47.5% subjects. According to the currently accepted guidelines, 47.0% of all the individuals were candidates for at least one of the three aforementioned drugs--22.9% needed only one drug, 17.8% needed only two drugs and 6.3% needed all the three drugs. Requirement of the treatment was much higher in the highest age-tertile (>50 years of age) with 78.0% needing at least one medication, 45.1% needing at least two medications and 12.6% needing all the three drugs (p value < 0.001). Of the different drugs, aspirin was the most commonly required medicine (38.3% of all) and a combination of aspirin and statin was the most commonly required two-drug combination.
Conclusions: The present study shows that, in spite of high prevalence of CV risk factors, a majority of office-executives who are free of CVD do not require multi-drug therapy for primary prevention of CVD as per the current recommendations. Though a greater proportion of the individuals > 50 years of age require drug therapy, even among them, a triple-drug combination is warranted only in a small proportion of subjects. When needed, a combination of statin and aspirin is the most commonly required combination.