[Cardiovascular disease in those aged 55 years and over controlled with a combined pill against 4 risk factors: some brief comments].
It was recently proposed that people with a high absolute cardiovascular risk, for example those aged 55 years and over, might considerably benefit from a combined pill that includes proven treatments such as a statins, antihypertensives, antiplatelet therapy and folic acid. Although conceptually attractive, certain negative effects need to be considered. A strategy to treat the population aged 55 years and over might yield large benefits in high-risk patients with fairly normal values for risk factors that are currently often left untreated. It may, however, also lead to the undertreatment of patients with abnormally high values of individual risk factors and to the overtreatment of low-risk patients. In these low-risk patients, the side effects of aspirin and blood-pressure lowering treatment might outweigh the benefits. Due to the high costs and also the availability of generic drugs, it is difficult to envision trials that will address these issues. Therefore, the acceptance and implementation of this intriguing concept by health authorities and insurance companies remains doubtful.
Rabelink
T J
TJ
Universitair Medisch Centrum Utrecht, divisie Interne Geneeskunde en Dermatologie, Postbus 85.500, 3508 GA Utrecht. t.rabelink@azu.nl
D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D012307:Risk Factors
D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D005492:Folic Acid