[en] The concept of "polypill" for cardiovascular prevention was introduced in 2003 in a landmark paper of the British Medical Journal. A model based on results provided by evidence-based medicine suggested that a "polypill", that contains a statin, three blood pressure lowering drugs (each at half standard dose), aspirin and folic acid, would result in an 80% reduction in the incidence of coronary and cerebrovascular events, while being associated with a good tolerance profile and offering a favourable cost-effectiveness ratio. The present paper aims at presenting the new advances dealing with this new paradigm in cardiovascular prevention. We will present the progresses of the "polypill" concept since 2003, the results of a first controlled clinical trial, the pharmaceutical feasibility for routine clinical use and the potential pharmaco-economical impacts of such a strategy. The "polypill" may offer a solution to avoid physician's clinical inertia and reduce patients's lack of compliance, two drawbacks in the field of cardiovascular prevention. [fr] Le concept de la «polypill» pour la prévention des maladies cardio-vasculaires a été mis en exergue en 2003 dans le British Medical Journal. Une analyse modélisée des données de la médecine factuelle suggérait que la prescription d’une combinaison de six médicaments – une statine, trois anti-hypertenseurs à faibles doses, de l’aspirine et de l’acide folique – permettrait de réduire d’environ 80 % les accidents coronariens et cérébro-vasculaires, sans entraîner de manifestations indésirables notables et avec un rapport coût-efficacité favorable. Le présent article vise à faire le point, quelques années plus tard, sur les avancées concernant ce nouveau paradigme en prévention cardio-vasculaire. Nous envisagerons successivement les progrès conceptuels concernant la «polypill» depuis 2003, les résultats d’un premier essai clinique contrôlé, la faisabilité pharmaceutique dans une perspective de routine clinique et les impacts pharmaco-économiques possibles d’une telle stratégie. La « polypill » pourrait offrir une solution pour limiter l’inertie clinique du médecin et remédier au manque d’observance du patient, deux fléaux dans le domaine de la prévention cardio-vasculaire.
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 :
Prevention cardio-vasculaire: la "polypill", une solution pour vaincre l'inertie clinique et le manque d'observance?
Alternative titles :
[en] Cardiovascular prevention: could the polypill reduce the risk of clinical inertia and poor compliance?
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