title: Triple Combination Therapy for Global Cardiovascular Risk: Atorvastatin, Perindopril, and Amlodipine.
abstract: Statins, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers (CCBs) have markedly changed the clinical progression of patients with coronary artery disease (CAD). The goal of this paper is to review the rationale and evidence for combining these three drug classes in hypertensive patients with hypercholesterolemia or CAD. Data sources include a literature search for publications on the use of a statin combined with various antihypertensive drugs in patients with hypertension and hypercholesterolemia or stable CAD. Hypercholesterolemia and hypertension constitute major physiological risk factors of ischemic heart disease. Current guidelines recommend a global approach to risk management, using agents that address as many risk factors as possible. Dual combination therapies are an important component of guideline-recommended therapy in hypertension. Our review of the literature indicates that triple therapy with a statin, ACE inhibitor, and CCB is associated with a significant reduction in major cardiovascular events. For example, a post hoc analysis in 1056 patients with stable CAD participating in the EUROPA trial indicated that the addition of perindopril to a CCB and a lipid-lowering agent was associated with a 46 % reduction in the composite of cardiovascular death, myocardial infarction, and resuscitated cardiac arrest (p = 0.023). In addition, single pill formulations are known to result in better adherence to the treatment. Single-pill formulations that combine a statin, an ACE inhibitor, and a CCB appear to offer an effective approach to the management of global cardiovascular risk.
authors.affiliation: Lille Heart Institute, 139 C-76 rue de Lille Lambersart, 59037, Lille, France. mbertrand2007@gmail.com.
authors.forename: Michel E
authors.initials: ME
authors.lastname: Bertrand
authors.affiliation: 1st Cardiology Department, Athens Medical School, Athens, Greece.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Vlachopoulos
authors.affiliation: Hypertension Excellence Centre, CHU Avicenne-AP-HP, and Paris 13 University (EA 3412), Bobigny, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Mourad
mesh_terms: D017311:Amlodipine / Q000627:therapeutic use*; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D000069059:Atorvastatin / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D020913:Perindopril / Q000627:therapeutic use*; D012307:Risk Factors
chemical_list: D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D017311:Amlodipine; D000069059:Atorvastatin; D020913:Perindopril