Abstract
Ischemic heart disease and stroke are the leading causes of death worldwide. A large proportion of individuals at high 10-year risk of a cardiovascular event live in low-income and middle-income countries, and the large majority of all cardiovascular events occur in developing countries. A large amount of evidence supports the use of pharmacological treatment for the prevention of cardiovascular death in this population, including antiplatelet drugs, beta blockers, lipid-lowering agents and angiotensin-converting-enzyme inhibitors. However, the efficacy of cardiovascular prevention is hampered by several problems, including inadequate prescription of medication, poor adherence to treatment, limited availability of medications and unaffordable cost of treatment. Here we examine the use of fixed-dose combination therapy (a 'polypill'), and how this therapy could improve adherence to treatment, reduce the cost and improve treatment affordability in low-income countries.
Key Points
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In 2005, cardiovascular diseases caused 3.3 times more deaths worldwide than AIDS, tuberculosis and malaria combined
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Of all cardiovascular events that occur worldwide, four-fifths occur in low-income and middle-income countries
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Although the efficacy of medication for secondary prevention of cardiovascular disease has been clearly demonstrated, a large proportion of potential candidates for therapy do not receive adequate treatment
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Poor adherence to treatment and cost of medication are largely responsible for the discrepancy between evidence-based recommendations and actual treatment
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Complexity of treatment is the main cause of patients' lack of adherence
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Fixed-dose combination therapy (a 'polypill') might improve secondary prevention owing to a reduction in treatment complexity, and could provide medication at an affordable cost in developing countries
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Acknowledgements
Ariana Del Negro, Medscape Cardiology, New York, NY and Désirée Lie, University of California, Irvine, CA, are the authors of and are solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.
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Sanz, G., Fuster, V. Fixed-dose combination therapy and secondary cardiovascular prevention: rationale, selection of drugs and target population. Nat Rev Cardiol 6, 101–110 (2009). https://doi.org/10.1038/ncpcardio1419
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DOI: https://doi.org/10.1038/ncpcardio1419
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