Polypill reduced functional decline, but not cognitive decline in older adults

A pill containing antihypertensives and a statin, with or without aspirin, was associated with reduced functional decline, but not reduced cognitive decline, in those aged 65 years and older, researchers reported in JAMA Neurology.

“Vascular risk factors are associated with cognitive decline, but studies addressing individual risk factors have not demonstrated an effect of risk factor management on the preservation of cognition,” Jacquelin J. Bosch, PhD, of McMaster University and Hamilton Health Sciences in Ontario, Canada, and colleagues wrote.

Bosch and colleagues conducted a randomized clinical trial among adults aged 65 years and older to determine if a polypill, which contained atenolol 100 mg, hydrochlorothiazide 25 mg, ramipril 10 mg and simvastatin 40 mg, could reduce cognitive and functional decline in those with no known cardiovascular disease but intermediate risk.

Participants were recruited from hospital and community-based centers in eight countries, and 2,098 people aged 65 years and older at intermediate risk of cardiovascular disease were included in the study. Cognitive and functional assessments were given at baseline, 2 years and at the end of the study after 5 years.

Researchers found that among all participants (mean age, 70.1 years; 60% female), 86% had hypertension (n = 1,796), and 32% (n = 680) had impaired fasting plasma glucose levels. Mean baseline systolic blood pressure was 146.1 mm Hg, and mean low-density lipoprotein cholesterol was 124.3 mg/dL.

Among those in the polypill group, mean blood pressure decreased by 5.7 mm Hg, and mean cholesterol decreased by 24 mg/dL. In the same group, functional decline was reduced during follow-up, compared with those who received placebo (mean Standard Assessment of Global Everyday Activity [SAGEA] scores, 0.06 vs. 0.15) and it was also reduced in those who received the polypill and aspirin compared with those who received placebo (mean SAGEA scores, 0.01 vs. 0.14).

The authors said that the polypill with or without aspirin had no effect on reducing the risk of cognitive decline or dementia.

“Our findings emphasize the importance of extending outcomes in cardiovascular trials to routinely include measures of functional status,” Bosch and colleagues wrote. “The SAGEA scale used in this trial was specifically developed to measure changes in cognitive, instrumental and basic function, which are most vulnerable to decline due to vascular disease.”