[Optimizing long-term therapy: dawn of a new era].
The combination of a beta-blocker, a platelet inhibitor, a statin and an ACE inhibitor (B.A.S.I.C. regimen) provides major therapeutic benefits in the management of coronary patients. In patients receiving the quadruple combination, the overall mortality risk is 75% lower than for patients receiving none of these four therapies. According to the data from the PREVENIR III study, the combination of a statin and a platelet inhibitor reduces the risk of recurrent coronary events by 71%, the risk of recurrent vascular events by 65% and the risk of death from all causes taken together by 68%, when compared with the absence of these two medications. In the French USIC 2000 survey, prescription of the triple combination of platelet inhibitor, statin and beta-blocker is also associated with a 50% reduction in overall mortality. However, although the B.A.S.I.C. strategy is of major therapeutic value, it markedly increases the number of tablets to be taken every day. Treatment compliance, which is a predictive factor for overall mortality in diabetic coronary patients, diminishes markedly as the number of medications to be taken every day increases. The availability of fixed combinations, e.g. statin-acetylsalicylic acid, thus makes it possible to reduce the number of tablets to be taken at any one time, thus potentially increasing treatment compliance and the efficacy of the treatment administered.
Danchin
Nicolas
N
Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France. nicolas.danchin@egp.aphp.fr
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D003327:Coronary Disease / Q000188:drug therapy* / Q000401:mortality; D004338:Drug Combinations; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012306:Risk
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004338:Drug Combinations; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors