[Management of different cardiovascular risk factors with a combination tablet (polypill)].
BACKGROUND
The multifactorial origin of cardiovascular diseases has led to polypharmacy in primary and secondary prophylaxis with evidence-based medications, such as statins, antihypertensive drugs and platelet aggregation inhibitors. The number of prescribed drugs correlates inversely to adherence and can lead to treatment failure. Fixed-dose combination drugs (polypills) could increase the medication adherence of patients, reduce risks and prevent cardiovascular events.


METHODS
This review is based on publications that were retrieved from Medline (via PubMed) and The Cochrane Library. The clinical database ClinicalTrials.gov. was also considered.


RESULTS
In the studies on primary prevention conducted to date, fixed-dose combinations showed a superior control of risk factors, e.g. hypertension and low-density lipoprotein (LDL) cholesterol compared to placebo and at least non-inferiority compared to usual care. In secondary prevention, the effect of the polypill is mostly on the reduction of blood pressure and LDL cholesterol in non-adherent patients; however, evidence that fixed-drug combinations reduce cardiovascular morbidity and mortality compared to standard therapy is lacking.


CONCLUSIONS
The polypill can be considered as an alternative to polypharmacy after a risk-benefit assessment, especially in non-adherent patients. Ongoing studies are investigating the effect of the polypill on cardiovascular events. Current polypills are limited by the lack of sufficient dosages of the individual components to avoid overtreatment and undertreatment at the individual treatment level.
Institut für Pharmakologie und Präventive Medizin, Mahlow, Deutschland. peter.bramlage@ippmed.de.
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http://orcid.org/0000-0003-4970-2110
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Bramlage
Medizinische Klinik V (Nephrologie, Hypertensiologie, Rheumatologie, Endokrinologie, Diabetologie), Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland.|Klinisches Institut für Medizinische und Chemische Labordiagnostik, Medizinische Universität Graz, Graz, Österreich.|Synlab Akademie, synlab Holding Deutschland GmbH, Mannheim und Augsburg, Deutschland.
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März
Klinik und Poliklinik für Allgemeine und Interventionelle Kardiologie, Universitätsklinikum Eppendorf, Hamburg, Deutschland.|Universitäres Herzzentrum Hamburg, Hamburg, Deutschland.
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Westermann
Institut für Sportwissenschaft, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland.
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Weisser
Kardiologische Gemeinschaftspraxis, Dinslaken, Deutschland.
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Wirtz
Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Deutschland.|Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Deutschland.
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Zeymer
Medizinische Klinik I, Clemenshospital Münster, Akad. LKH der Universität Münster, Münster, Deutschland.
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Baumgart
Institut für Pharmakologie und Präventive Medizin, Mahlow, Deutschland.
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van Mark
Klinik für Innere Medizin III, Universitätsklinikum des Saarlands, Homburg/Saar, Deutschland.
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Laufs
Medizinische Klinik V (Nephrologie, Hypertensiologie, Rheumatologie, Endokrinologie, Diabetologie), Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland.
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Krämer
CARIM School for Cardiovascular Diseases, Maastricht University, PO Box 616, 6200 MD, Maastricht, Niederlande.
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Unger
D000959:Antihypertensive Agents; D002317:Cardiovascular Agents; D002318:Cardiovascular Diseases; D004338:Drug Combinations; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D012307:Risk Factors; D013607:Tablets
D000959:Antihypertensive Agents; D002317:Cardiovascular Agents; D004338:Drug Combinations; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D013607:Tablets
Cardiovascular prevention; LDL cholesterol; Platelet aggregation inhibitors; Polypill; Systolic blood pressure