Information regarding polypill treatment is lacking.

We read with interest the recently published clinical trial of Mann et al., 1 Mann J.F.E. Joseph P. Gao P. et al. TIPS-3 investigators. Effects of aspirin on cardiovascular outcomes in patients with chronic kidney disease. Kidney Int. 2023; 103: 403-410 Abstract Full Text Full Text PDF Scopus (5) Google Scholar which is a subgroup analysis of the International Polycap Study-3 (TIPS-3) trial. 2 Yusuf S. Joseph P. Dans A. et al. Polypill with or without aspirin in persons without cardiovascular disease. N Engl J Med. 2021; 384: 216-228 Crossref PubMed Scopus (121) Google Scholar The TIPS-3 trial was a double-blinded, 2-by-2-by-2 factorial randomized controlled trial, including participants, without history of cardiovascular disease, with intermediate or high cardiovascular risk. Interventions were daily polypill (containing simvastatin, atenolol, hydrochlorothiazide, and ramipril) versus placebo; aspirin, 75 mg/d, versus placebo; and vitamin D versus placebo. The TIPS-3 trial concluded that the combination of polypill plus aspirin led to a lower incidence of cardiovascular events. The present post hoc analysis 1 Mann J.F.E. Joseph P. Gao P. et al. TIPS-3 investigators. Effects of aspirin on cardiovascular outcomes in patients with chronic kidney disease. Kidney Int. 2023; 103: 403-410 Abstract Full Text Full Text PDF Scopus (5) Google Scholar analyzed the effects of aspirin on cardiovascular outcome in patients with versus without chronic kidney disease. The researchers divided the cohort into 2 groups: 2860 patients assigned to aspirin, and 2853 patients assigned to placebo. However, they did not insist enough, in our opinion, on the fact that, in the aspirin group and in the placebo group, 1432 and 1429 patients were also taking the polypill, respectively. When the authors further divided the cohort according to baseline estimated glomerular filtration rate (<60 or ≥60 ml/min and estimated glomerular filtration rate tertiles), the rate of patients receiving polypill in each group was not reported. Hence, the TIPS-3 trial has proven that polypill was effective in reducing incidence of cardiovascular events. 1 Mann J.F.E. Joseph P. Gao P. et al. TIPS-3 investigators. Effects of aspirin on cardiovascular outcomes in patients with chronic kidney disease. Kidney Int. 2023; 103: 403-410 Abstract Full Text Full Text PDF Scopus (5) Google Scholar Consequently, these missing data might be important to better interpret the results of Mann et al. Effects of aspirin on cardiovascular outcomes in patients with chronic kidney diseaseKidney InternationalVol. 103Issue 2PreviewPatients with chronic kidney disease (CKD) carry a high cardiovascular (CV) risk. Since whether this risk is reduced by aspirin is unclear, we examined if the effect of aspirin on cardiovascular outcomes varied by baseline kidney function in a primary cardiovascular disease prevention trial. The International Polycap Study-3 (TIPS-3) trial had randomized people without previous cardiovascular disease to aspirin (75 mg daily) or placebo. We now examined aspirin versus placebo on cardiovascular events in participants grouped by estimated glomerular filtration rate (eGFR), using a threshold of 60 ml/min/1.73 m2, and by using tertiles of eGFR. Full-Text PDF The authors replyKidney InternationalVol. 103Issue 6PreviewWe thank Dufour and Devresse1 for their interest in our report.2 Indeed, the International Polycap Study-3 trial used a 3-way factorial design to examine the effects of aspirin, of a polypill (containing atenolol, ramipril, simvastatin, and hydrochlorothiazide), and of vitamin D versus respective placebo. In our present report, we address the effects of aspirin versus placebo in those with an estimated glomerular filtration rate of <60 ml/min per 1.73 m2. No interaction of polypill (P = 0.9853) or vitamin D (P = 0.8345) with aspirin’s effects versus placebo was found (see also Methods section). Full-Text PDF