[Can cardiovascular diseases be reduced over 80% by a "superpill"? Review on the epidemiological study from Wald and Law, 2003].
As a consequence of our "western" diet and lifestyle, the risk for cardiovascular diseases is increased in the western world. It can be decreased by influencing the LDL-cholesterol values, the blood pressure and the platelet aggregation. It is, however, not proven that lowering of serum homocysteine levels reduces the risk forcardiovascular diseases. Wald and Law suggest in their epidemiological study a polypill, which has as its ingredients a statin, an anti-hypertonic drug, folic acid, and aspirine. Overall, the risk reduction by a polypill is overestimated, since a threshold is currently not existing, in all drugs side effects and interactions are possible, pharmaceuticals are only labelled for specific indications, and with missing efficacy there could be a negative risk-benefit-relation. Indeed, a combined therapy with different drugs is in place in patients with higher risk and for secondary prevention, which is already risk-adjusted. The use of effective drugs, however, in patients without evidence of a positive risk-benefit-relation and without medical control cannot be justified. Therefore, the application of the polypill for subjects beyond 55 years of age is an illusion; by contrast, treatment of patients with a high risk for atherosclerotic diseases is already reality.
Wink
K
K
Medizinische Fakultät der Albert-Ludwigs-Universität Freiburg. kwink@t-online.de
Otte
A
A
D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004338:Drug Combinations; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D020521:Stroke / Q000517:prevention & control*; D015996:Survival Rate
D002317:Cardiovascular Agents; D004338:Drug Combinations