[Prevention of cardiovascular diseases using a combined pharmacological approach: is there any place for a "polypill"?].
In the June 28, 2003 issue of the British Medical Journal, an extensive literature survey based on various large meta-analyses of the efficacy and safety of the reduction of four cardiovascular risk factors (cholesterol, arterial blood pressure, platelet aggregation, homocysteine) leads to the conclusion that a combined pharmacological intervention should reduce ischaemic heart disease events by 88% and strokes by 80% in at risk individuals. Therefore, a new paradigm is proposed for the prevention of cardiovascular diseases. This new strategy would consist in the systematic prescription to people with a history of heart attack or stroke, those with any form of obliterative atherosclerotic vascular disease or diabetes, and everyone aged 55 and older of a fixed combination of 6 pharmacological agents independently of initial risk factor profile.... Such pharmacological formulation, called "polypill", should contain a statin, three blood pressure lowering drugs (each at half standard dose), aspirin (75 mg/day) and folic acid (0.8 mg/day). We discuss the pros and cons of this new paradigm. However, the efficacy of such "polypill" remains to be demonstrated in a large controlled clinical trial as well as its superiority as compared to a classical approach of cardiovascular prevention based upon the individual optimal correction of each risk factor thanks a dose titration of each pharmacological compound.
Scheen
A J
AJ
Services de Diabétologie, Nutrition et Maladies métaboliques et de Médecine interne générale, Département de Médecine, CHU Sart Tilman, Liège.
Lefèbvre
P J
PJ
Kulbertus
H
H
D000959:Antihypertensive Agents / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D004338:Drug Combinations; D005492:Folic Acid / Q000008:administration & dosage; D006397:Hematinics / Q000008:administration & dosage; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage
D000959:Antihypertensive Agents; D004338:Drug Combinations; D006397:Hematinics; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D005492:Folic Acid; D001241:Aspirin