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Vol. 64. Issue S2.
Problemas relevantes en cardiología 2010
Pages 3-9 (July 2011)
(Spanish Only)
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Vol. 64. Issue S2.
Problemas relevantes en cardiología 2010
Pages 3-9 (July 2011)
(Spanish Only)
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Compuestos de dosis fija en la prevención secundaria de la cardiopatía isquémica
Fixed-Dose Compounds and the Secondary Prevention of Ischemic Heart Disease
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Valentín Fustera,b, Ginés Sanzb
a Mount Sinai Medical Center, Nueva York, Estados Unidos
b Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España
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Worldwide, the leading causes of death are ischemic heart disease and stroke. Moreover, patients with several risk factors or a history of ischemic heart disease are at a high risk of coronary event recurrence. There is evidence that primary cardiovascular disease prevention programs are effective when applied to the general population. However, therapeutic strategies designed to control several risk factors simultaneously in patients without evidence of cardiovascular disease are expensive and difficult to implement. In contrast, combination drug therapy is commonly used for secondary cardiovascular revention and its beneficial effects on morbidity and mortality have been clearly demonstrated. evertheless, the actual impact of this approach is less than might be expected, partly because of poor dherence to drug regimens and the high cost of treatment in low- and middle-income countries. In patients who have had an acute myocardial infarction, the complexity of the regimen is inversely correlated ith compliance and is, in most cases, the reason for treatment discontinuation. Moreover, globally the ast majority of cardiovascular events take place in developing countries with limited health resources here access to treatment is poor. The development of fixed-dose combinations of drugs (i.e. polypills) esigned for the treatment of myocardial infarction patients could help overcome these limitations, mprove compliance and facilitate the distribution of and access to treatment in developing countries. We ave begun a large clinical trial in five countries to investigate the beneficial effects of treatment using a olypill (i.e. aspirin, an angiotensin-converting enzyme inhibitor and a statin) on ischemic heart disease ecurrence. The results of this study could provide the basis for a new therapeutic approach to the anagement of not only cardiovascular disease but also diabetes and stroke.

Keywords:
Ischemic heart disease
Polypill
Secondary prevention

La cardiopatía isquémica y los accidentes cerebrovasculares constituyen la primera causa de muerte en el mundo. Los pacientes con varios factores de riesgo o con historia clínica de cardiopatía isquémica tienen un riesgo elevado de recurrencia de nuevos episodios coronarios. Existen datos que demuestran la eficacia de los programas de prevención cardiovascular primaria cuando se aplican a la población general. Sin embargo, las estrategias terapéuticas dirigidas a controlar simultáneamente diversos factores de riesgo en pacientes que no tienen una enfermedad cardiovascular declarada son costosas y difíciles de llevar a la práctica. Por el contrario, el tratamiento farmacológico combinado es una práctica habitual en la prevención cardiovascular secundaria y sus beneficios en la morbimortalidad están ampliamente documentados. A pesar de ello, el impacto real de esta estrategia es menor de lo que cabría esperar, en parte debido a la pobre adherencia al régimen terapéutico y el elevado coste del tratamiento en países con rentas medias y bajas. La complejidad de la pauta terapéutica en pacientes que han tenido un infarto agudo de miocardio se correlaciona inversamente con su cumplimiento y es, en la mayoría de los casos, causa del abandono de la medicación. Por otra parte, la gran mayoría de los episodios cardiovasculares que ocurren en el mundo tienen lugar en países en desarrollo, con recursos sociosanitarios limitados y escaso acceso al tratamiento. El desarrollo de combinaciones farmacológicas de dosis fijas (polipastillas) dirigidas al tratamiento de los pacientes con infarto de miocardio puede ayudar a superar estas limitaciones y mejorar la adherencia y facilitar la distribución y el acceso a la medicación en países en desarrollo. Hemos iniciado un gran estudio clínico en cinco países para investigar los beneficios del tratamiento con polipastilla (aspirina, inhibidor de la enzima de conversión de la angiotensina y estatina) en la recurrencia de la cardiopatía isquémica. Los resultados de este estudio pueden establecer las bases de un nuevo enfoque terapéutico no sólo para el manejo de la enfermedad cardiovascular, sino también para la diabetes y los accidentes cerebrovasculares.

Palabras clave:
ardiopatía isquémica
Polipastilla
Prevención secundaria
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Bibliografía
[1]
Heart Protection Study Collaborative roup. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet. 2003; 361:2005-16.
[2]
Two decades of progress in preventing vascular disease. Lancet. 2002; 360:2-3.
[3]
A strategy to reduce cardiovascular disease by more than 80%. BMJ. 2003; 326:1419.
[4]
Effect of combinations of drugs on all cause mortality in patients with ischaemic heart disease: nested case-control analysis. BMJ. 2005; 330:1059-63.
[5]
Angiotensin-converting-enzyme inhibitors in stable vascular disease without left ventricular systolic dysfunction or heart failure: a combined analysis of three trials. Lancet. 2006; 368:581-8.
[6]
Fixed-dose combinations improve medication compliance: a meta-analysis. Am J Med. 2007; 120:713-9.
[7]
The year in atherothrombosis. J Am Coll Cardiol. 2009; 53:1326-37.
[8]
EUROASPIRE Study Grou p. Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I. II, and III surveys in eight European countries. Lancet. 2009; 373:929-40.
[9]
Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U; EUROASPIRE Study Grou p. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil. 2009;16:121-37.
[10]
The availability and affordability of selected essential medicines for chronic diseases in six lowand middle-income countries. Bull World Health Organ. 2007; 85:279-88.
[11]
Compliance with antihypertensive therapy in the elderly: a comparison of fixed-dose combination amlodipine/benazepril versus componentbased free-combination therapy. Am J Cardiovasc Drugs. 2008; 8:45-50.
[12]
Low priority of cardiovascular and chronic diseases on the global health agenda: a cause for concern. Circulation. 2007; 116:1966-70.
[13]
American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heartdisease and stroke statistics —2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006; 113:e85-e151.
[14]
Issues to consider in the pharmaceutical development of a cardiovascular polypill. Nat Clin Pract Cardiovasc Med. 2009; 6:112-9.
[15]
Indian Polycap Study (TIPS). Effects of a polypill (Polycap) on risk factors in middle-aged individuals without cardiovascular disease (TIPS): a phase II, double-blind, randomised trial. Lancet. 2009; 373:1341-51.
[16]
A polypill for secondary prevention: time to move from intellectual debate to action. Nat Clin Pract Cardiovasc Med. 2007; 4:173.
[17]
Fixed-dose combination therapy and secondary cardiovascular prevention: rationale, selection of drugs and target population. Nat Clin Pract Cardiovasc Med. 2009; 6:101-10.
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Revista Española de Cardiología (English Edition)

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