In over 65-year-olds with intermediate risk for cardiovascular disease who took the contraceptive pill with antihypertensive drugs and with a statin, functional losses (as measured by the Standard Assessment of Global Everyday Activities scale) were significantly reduced over 5 years compared to placebo . The cognitive losses did not differ between the two groups [1].
How can cardiovascular and neurodegenerative risks be reduced?
The background: There is an association between vascular risk factors and declining cognitive performance. However, according to the authors of the current study, the attempt to modify individual risk factors has not shown any effect in preserving cognitive performance.
They therefore wanted to test whether a polypill with antihypertensive drugs and a statin would reduce cognitive and functional decline in people with cardiovascular risk factors but no manifest diseases.
Study with almost 2,400 subjects
For the randomized study Polycap 3 (TIPS-3), researchers recruited 2,389 participants who were at least 65 years of age and had an intermediate risk of cardiovascular disease. Subjects received a polypill (simvastatin 40 mg, atenolol 100 mg, hydrochlorothiazide 25 mg, ramipril 10 mg) vs placebo, ASA 75 mg vs placebo, or vitamin D vs placebo in a 2x2x2 factorial design. Not all study arms are reported in the current work.
88% of all subjects completed the initial and final examination. They were 70.1 years old on average and 60% were female. The primary objective of the study was a composite of the proportion of participants whose cognitive or functional ability declined by more than 1.5 standard deviations over 5 years.
Less functional impairment – no effect on cognition
The results at a glance:
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Under the polypill, the average systolic blood pressure decreased by 5.7 mmHg from 146.1.
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Average LDL cholesterol decreased by 24 mg/dl from 124.3.
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At the 5-year follow-up, there were no significant differences in cognition loss between the polypill and placebo. The number of participants with substantial cognitive impairment was 356 versus 328. Dementia was diagnosed in 2 participants on the polypill and in 4 placebo recipients.
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On a functional level, the decrease was less with the polypill at 0.06 than with placebo (0.15) as measured by Global Everyday Activities scores. The combination of polypille and ASA was also better than placebo (0.14) at 0.01, and the difference was statistically significant in both comparisons (p=0.01).
„In older people with intermediate cardiovascular risk, the polypille with and without aspirin was associated with a reduction in functional losses, while cognition was preserved no better than with placebo,” the authors conclude.
The article originally appeared on Univadis.de.
