Should we be more aggressive in the therapy against cardiovascular risk factors? Should we prescribe statin and aspirin for every diabetic patient, or is it time for a polypill?
The reality of primary and secondary prevention of cardiovascular complications in people with diabetes is alarming, even in developed countries with a well-structured medical system. Even though therapeutic targets have been more clearly defined during the last decades, their implementation is still suboptimal. Financial and structural reasons, insufficient information of physicians and patients, along with a low compliance of the latter are only a few reasons that have been incriminated. To eliminate some of these inconveniences, attempts to standardize and simplify therapies have been made. Treatment with aspirin and statin for every patient with diabetes has been postulated. Some went even further, developing the concept of a "polypill," an integrated pharmacological agent with up to six different compounds meant to prevent cardiovascular disease in the broad population. Likewise, the idea of a "polymeal" tries to implement healthy nutrients into the populations' lifestyle in a standardized fashion. Our article highlights some of the advantages and pitfalls of these concepts and reflects our point of view with regard to some treatment aspects in people with diabetes. As part of a pro and contra discussion, our article is arguing against the use of statins in all patients with diabetes and especially against the indiscriminate use of a polypill.
Stirban
Alin O
AO
Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
Tschoepe
Diethelm
D
D001241:Aspirin / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D002986:Clinical Trials as Topic; D003925:Diabetic Angiopathies / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D004359:Drug Therapy, Combination; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D011322:Primary Prevention
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin