Abstract
Ischemic heart disease and stroke are the leading causes of death worldwide. What
was once thought to be an endemic disease of high income countries has become a global
epidemic, as low and middle income countries have adopted Western lifestyles, to the
point that noncommunicable diseases are now the main cause of death in these regions,
above and beyond communicable diseases, malnutrition, and injury. As a result, a large
proportion of individuals at high 10-year risk of a cardiovascular event live in low-
and middle-income countries, and the most 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, β-blockers, lipid-lowering agents, and angiotensin-converting enzyme inhibitors,
however, the efficacy of cardiovascular event 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, and how this therapy could improve adherence
to treatment, reduce the cost, and improve treatment affordability in low-income countries.
Résumé
La cardiopathie ischémique et l’accident cérébral vasculaire sont les principales
causes de décès à travers le monde. Ce qui était jadis considéré comme une maladie
endémique des pays à revenu élevé est devenu une épidémie mondiale, à mesure que les
pays à revenu faible et à revenu moyen ont adopté le mode de vie occidentale, si bien
que les maladies non transmissibles sont maintenant la cause principale de décès dans
ces régions après les maladies transmissibles, la malnutrition et les traumatismes.
Par conséquent, une grande proportion d’individus exposés à un risque élevé d’événements
cardiovasculaires sur une période de 10 ans vivent dans des pays à faible revenu et
à revenu moyen, et la plupart de tous les événements cardiovasculaires apparaissent
dans les pays en voie de développement. Un grand nombre de données scientifiques soutiennent
l’utilisation du traitement pharmacologique pour prévenir la mortalité cardiovasculaire
de cette population, incluant les antiagrégants plaquettaires, les β-bloqueurs, les
hypolipidémiants et les inhibiteurs de l’enzyme de conversion de l’angiotensine. Cependant,
les divers problèmes, dont les ordonnances de médicaments inadéquates, la mauvaise
observance du traitement, la disponibilité limitée des médicaments et le coût inabordable
du traitement nuisent à l’efficacité de la prévention des événements cardiovasculaires.
Ici, nous examinons l’utilisation du traitement combiné à dose fixe et la manière
avec laquelle ce traitement améliorerait l’observance au traitement, réduirait le
coût et améliorerait l’accessibilité du traitement dans les pays à faible revenu.
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Article info
Publication history
Published online: March 03, 2014
Accepted:
February 11,
2014
Received:
October 1,
2013
Footnotes
See page 525 for disclosure information.
Identification
Copyright
© 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
