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Polypill strategy at the heart of cardiovascular secondary prevention

2018; BMJ; Volume: 105; Issue: 1 Linguagem: Inglês

10.1136/heartjnl-2018-313464

1468-201X

Borja Ibáñez, José M. Castellano, Valentı́n Fuster,

Pharmaceutical industry and healthcare

Over recent decades, cardiovascular disease (CVD) has overtaken infectious diseases as the leading cause of death worldwide.1 This shift is partly due to the great advances in the treatment of infectious diseases and the success of associated public health campaigns. General public awareness of the importance of both preventing high-risk exposure and early therapy initiation and adherence has helped reduce the burden of communicable (infectious) diseases. This contrasts sharply with the story of non-communicable diseases such as CVD. The incidence of atherosclerosis (the single largest underlying cause of CVD) has increased exponentially due to the immense lifestyle changes witnessed first in developed countries but lately also in low-income and middle-income countries. This rapid worldwide change in lifestyle has resulted in dramatic increases of obesity, sedentarism, dyslipidaemia and hypertension, all of which are risk factors for atherosclerosis. The control of modifiable cardiovascular risk factors, such as lipid levels and blood pressure, has a clear impact in reducing the likelihood of experiencing a cardiovascular event, and this holds true for both primary and secondary prevention. The leading cardiovascular scientific societies dedicate major efforts to providing guidelines to enable clinicians to define specific targets for each of these modifiable factors based on a patient’s risk profile. The most recent European Society of Cardiology (ESC) ‘Guidelines on cardiovascular disease prevention in clinical practice’, released in 2016, established low-density lipoprotein (LDL) cholesterol targets of 70, 100 and 115 mg/dL for individuals at very high, high and low-to-moderate risk, respectively, and a blood pressure target of <140/90 mm Hg (140/85 mm Hg for most patients with diabetes).2 The identification of risk factors allows gross prediction of future cardiovascular events such as myocardial infarction (MI) and stroke. Patients experiencing an acute cardiovascular event today have a high likelihood of surviving the episode thanks to the great therapeutic advances in MI and other acute …