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Canadian Journal of Cardiology

Evolution of the Polypill Concept and Ongoing Clinical Trials

Published:March 03, 2014DOI:https://doi.org/10.1016/j.cjca.2014.02.016

      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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