[en] In the June 28, 2003 issue of the British Medical Journal, an extensive literature survey based on various large meta-analyses of the efficacy and safety of the reduction of four cardiovascular risk factors (cholesterol, arterial blood pressure, platelet aggregation, homocysteine) leads to the conclusion that a combined pharmacological intervention should reduce ischaemic heart disease events by 88% and strokes by 80% in at risk individuals. Therefore, a new paradigm is proposed for the prevention of cardiovascular diseases. This new strategy would consist in the systematic prescription to people with a history of heart attack or stroke, those with any form of obliterative atherosclerotic vascular disease or diabetes, and everyone aged 55 and older of a fixed combination of 6 pharmacological agents independently of initial risk factor profile.... Such pharmacological formulation, called "polypill", should contain a statin, three blood pressure lowering drugs (each at half standard dose), aspirin (75 mg/day) and folic acid (0.8 mg/day). We discuss the pros and cons of this new paradigm. However, the efficacy of such "polypill" remains to be demonstrated in a large controlled clinical trial as well as its superiority as compared to a classical approach of cardiovascular prevention based upon the individual optimal correction of each risk factor thanks a dose titration of each pharmacological compound.
Disciplines :
Pharmacy, pharmacology & toxicology Cardiovascular & respiratory systems
Author, co-author :
Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Lefebvre, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > Diabétologie,nutrition, maladies métaboliques
Kulbertus, Henri ; Université de Liège - ULiège > Services généraux (Faculté de médecine) > Relations académiques et scientifiques (Médecine)
Language :
French
Title :
Comment je previens ... les maladies cardio-vasculaires par une approche pharmacologique combinee: y a-t-il place pour une polypill"?"
Alternative titles :
[en] Prevention of cardiovascular diseases using a combined pharmacological approach: is there any place for a polypill"?"
Publication date :
2003
Journal title :
Revue Médicale de Liège
ISSN :
0370-629X
eISSN :
2566-1566
Publisher :
Université de Liège. Revue Médicale de Liège, Liège, Belgium
Kulbertus H, Scheen AJ.- Editorial. Numéro à thème et numéro d'été. Rev Med Liège, 2003, 58, 453-454.
Poncin J.- Vivre onze ans de plus avant l'infarctus. Le Soir, 26 juin 2003.
Wald NJ, Law MR.- A strategy to reduce cardiovascular disease by more than 80%. BMJ, 2003, 326, 1419-1423.
Rodgers A.- A cure for cardiovascular disease? Combination treatment has enormous potential, especially in developing countries. BMJ, 2003, 326, 1407-1408.
Task Force Report.- Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. Eur Heart J, 1998, 19, 1434-1503.
Ducobu J, Scheen AJ.- Les recommandations du Belgian Lipid Club pour le diagnostic et le traitement des hyperlipidémies: résumé pour le praticien. Rev Med Liège, 2000, 55, 360-366.
British Cardiac Society, British Hyperlipidaemia Association, British Hypertension Society, British Diabetic Association.- Joint British recommendations on prevention of coronary heart disease in clinical practice: summary. BMJ, 2000, 320, 705-708.
Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults.- Executive Summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA, 2001, 285, 2486-2497.
Scheen AJ, Rorive G, Kulbertus H.- Comment j'explore ... le risque coronarien individuel extrapolé à 10 ans. Rev Med Liège, 1999, 54, 118-121.
Scheen AJ.- Le risque cardio-vasculaire lié à l'hypercholestérolémie: d'un continuum à la notion de normalité, de seuil d'intervention et d'objectif thérapeutique. Rev Med Liège, 1999, 54, 17-21.
Scheen AJ.- Comment j'explore ... les secrets d'une méta-analyse. Rev Med Liège, 2003, 58, 41-46.
Law MR, Wald NJ, Rudnicka AR.- Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ, 2003, 326, 1423-1427.
Law MR, Wald NJ, Morris JK, Jordan RE.- Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ, 2003, 326, 1427-1431.
Antiplatelet Trialists' Collaboration.- Collaborative overview of randomised trials of antiplatelet therapy. I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ, 1994, 308, 81-105.
Antithrombotic Trialists' collaboration.- Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ, 2002, 324, 71-86.
Wald DS, Law M, Morris JK.- Homocysteine and cardiovascular disease: evidence on causality from a meta-anaysis. BMJ, 2002, 325, 1202-1206.
Homocysteine Lowering Trialists Collaboration.- Lowering blood homocysteine with folic acid based supplements: meta-analysis of randomised trials. BMJ, 1998, 316, 894-898.
Wald DS, Bishop L, Wald NJ, et al.- Randomized trial of folic acid supplementation and serum homocysteine levels. Arch Intern Med, 2001, 161, 695-700.
Heart Protection Study Collaborative Group.- MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high risk individuals. Lancet, 2002, 360, 7-22.
Hansson L, Zanchetti A, Carruthers SG, et al.- Effects of intensive blood pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet, 1998, 351, 1755-1762.
Scheen AJ, Kulbertus H.- Prévention cardio-vasculaire par les statines: faut-il encore doser le cholestérol? Rev Med Liège, 2003, 58, 191-197.
Scheen AJ.- La non-observance thérapeutique: problème majeur pour la prévention des maladies cardiovasculaires. Rev Med Liège, 1999, 54, 914-920.
World Health Organization.- Adherence to long-term therapies: Evidence for action. OMS, Genève, Suisse, 2003, 196 pages.
Paquot N, Scheen AJ.- Prévention cardio-vasculaire chez le patient diabétique de type 2. Rev Med Liège, 2003, 58, 271-27.
Gaede P, Vedel P, Larsen N, et al.- Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med, 2003, 348, 383-393.
http://bmj.com. Site du British Medical Journal consulté le 28 juillet 2003.
Conroy RM, Pyörälä K, Fitzgerald AP, et al on behalf of the SCORE project group.- Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J, 2003, 24, 987-1003.
DeBacker G, Ambrosioni E, Borch-Johnsen K, et al.- Executive Summary. European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and other Societies on cardiovascular disease prevention in clinical practice. Eur Heart J, 2003, 24, 1600-1609.