A new horizon in primary prevention of cardiovascular disease, can we prevent heart attack by "heart polypill"?

ardiovascular disease includes coronary heart disease and stroke. Together they are major causes of morbidity and mortality in many countries. In Iran, cardiovascular disease accounts for 45.7% of deaths. Cardiovascular disease is the well down which many Iranians will fall. Because cardiovascular disease is more common in older populations, it will become an increasing problem as the Iranian population ages. Is there anything we can do to mitigate the problem? The answer must be yes. Much of the epidemiology of cardiovascular disease is well understood. As a result we have a good understanding of how we could use this knowledge to prevent cardiovascular disease. This article will explain some of the most recent thoughts about how to prevent cardiovascular disease and how we could implement this in Iran.

[1]  黄亚明.  MedScape , 2009 .

[2]  M. Naghavi,et al.  Multi-constituent cardiovascular pills (MCCP)--challenges and promises of population-based prophylactic drug therapy for prevention of heart attack. , 2007, Current pharmaceutical design.

[3]  K. Reddy,et al.  The preventive polypill--much promise, insufficient evidence. , 2007, The New England journal of medicine.

[4]  G. Gensini,et al.  Can combining different risk interventions into a single formulation contribute to improved cardiovascular disease risk reduction? Rationale and design for an international, open-label program to assess the effectiveness of a single pill (amlodipine/atorvastatin) to attain recommended target levels , 2006, International journal of cardiology.

[5]  F. Zannad,et al.  Benefits, challenges, and registerability of the polypill. , 2006, European heart journal.

[6]  D. Lloyd‐Jones,et al.  Preventing Cardiovascular Disease in the 21st Century , 2006, American journal of cardiovascular drugs : drugs, devices, and other interventions.

[7]  O. Franco,et al.  The polypill: at what price would it become cost effective? , 2006, Journal of Epidemiology and Community Health.

[8]  Stephen W. Sorensen,et al.  Combination pharmacotherapy for cardiovascular disease prevention: threat or opportunity for public health? , 2005, American journal of preventive medicine.

[9]  S. Yusuf,et al.  WHO study on Prevention of REcurrences of Myocardial Infarction and StrokE (WHO-PREMISE). , 2005, Bulletin of the World Health Organization.

[10]  L. Green.  Prospects and possible pitfalls of a preventive Polypill: confessions of a health promotion convert , 2005, European Journal of Clinical Nutrition.

[11]  P. Doevendans,et al.  [The polypill: optimal strategy for reduction of cardiovascular disease]. , 2005, Nederlands tijdschrift voor geneeskunde.

[12]  M. Verhaar,et al.  [The polypill: not an effective strategy for reduction of cardiovascular disease]. , 2005, Nederlands tijdschrift voor geneeskunde.

[13]  J. Hippisley-Cox,et al.  Effect of combinations of drugs on all cause mortality in patients with ischaemic heart disease: nested case-control analysis , 2005, BMJ : British Medical Journal.

[14]  R. Collins,et al.  Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20 536 people with cerebrovascular disease or other high-risk conditions , 2004, The Lancet.

[15]  Daniel W. Jones,et al.  Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. , 2003, Hypertension.

[16]  Sonia S Anand.  Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. Law MR, Wald NJ, Rudnicka AR. BMJ 2003; 326: 1407-408. , 2003, Vascular medicine.

[17]  N J Wald,et al.  Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis , 2003, BMJ : British Medical Journal.

[18]  N J Wald,et al.  A strategy to reduce cardiovascular disease by more than 80% , 2003, BMJ : British Medical Journal.

[19]  N J Wald,et al.  Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials , 2003, BMJ : British Medical Journal.

[20]  R. Collins,et al.  Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial , 2003, The Lancet.

[21]  J. Shepherd,et al.  Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomized controlled trial , 2003 .

[22]  J. Mckenney,et al.  National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) , 2002 .

[23]  R. Collins,et al.  Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies , 2002, The Lancet.

[24]  P. Macfarlane,et al.  Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial , 2002, The Lancet.

[25]  D. Mark,et al.  Task force #2--the cost of prevention: can we afford it? Can we afford not to do it? 33rd Bethesda Conference. , 2002, Journal of the American College of Cardiology.

[26]  R Clarke,et al.  Underestimation of the importance of blood pressure and cholesterol for coronary heart disease mortality in old age. , 2002, European heart journal.

[27]  Nina Singh,et al.  Aspirin for the Primary Prevention of Cardiovascular Events: A Summary of the Evidence for the U.S. Preventive Services Task Force , 2002, Annals of Internal Medicine.

[28]  Catherine Sudlow,et al.  Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients , 2002, BMJ : British Medical Journal.

[29]  A. Wierzbicki,et al.  The GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) Study , 2002, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[30]  V. Athyros,et al.  Treatment with Atorvastatin to the National Cholesterol Educational Program Goal Versus 'Usual' Care in Secondary Coronary Heart Disease Prevention , 2002, Current medical research and opinion.

[31]  Jiang He,et al.  Effect of Statins on Risk of Coronary Disease: A Meta-analysis of Randomized Controlled Trials , 2000 .

[32]  J. Williamson,et al.  Therapeutic benefits of ACE inhibitors and other antihypertensive drugs in patients with type 2 diabetes. , 2000, Diabetes care.

[33]  S. Yusuf,et al.  Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. , 2000 .

[34]  S. Marks,et al.  Effecacy of 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitors for prevention of stroke , 1999, Journal of General Internal Medicine.

[35]  S. Ross,et al.  Clinical outcomes in statin treatment trials: a meta-analysis. , 1999, Archives of internal medicine.

[36]  Nick Freemantle,et al.  β Blockade after myocardial infarction: systematic review and meta regression analysis , 1999 .

[37]  G. Mancia,et al.  Prevention of coronary heart disease in clinical practice: recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. , 1998, Atherosclerosis.

[38]  C. Mulrow,et al.  Pharmacotherapy for hypertension in the elderly , 1998 .

[39]  M. Law,et al.  Homocysteine and ischemic heart disease: results of a prospective study with implications regarding prevention. , 1998, Archives of internal medicine.

[40]  R. McPherson,et al.  Rationale for and outline of the recommendations of the Working Group on Hypercholesterolemia and Other Dyslipidemias: interim report. Dyslipidemia Working Group of Health Canada. , 1998, The Canadian journal of cardiology.

[41]  J. Cutler,et al.  Effect of Antihypertensive Drug Treatment on Cardiovascular Outcomes in Women and Men , 1997, Annals of Internal Medicine.

[42]  I. U. Haq,et al.  Sheffield risk and treatment table for cholesterol lowering in prevention of coronary heart disease , 1995, The Lancet.

[43]  I. U. Haq,et al.  Sheffield risk and treatment table for cholesterol lowering for primary prevention of coronary heart disease , 1995, The Lancet.

[44]  David Miller,et al.  Cardiology in the Elderly , 1995 .

[45]  M. Law,et al.  Systematic underestimation of association between serum cholesterol concentration and ischaemic heart disease in observational studies: data from the BUPA study , 1994, BMJ.

[46]  Walker,et al.  Collaborative overview of randomised trials of antiplatelet therapy Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients , 1994 .

[47]  E. J. Brown,et al.  Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. , 1992, The New England journal of medicine.

[48]  W. Willett,et al.  A prospective study of plasma homocyst(e)ine and risk of myocardial infarction in US physicians. , 1992, JAMA.

[49]  R. Collins,et al.  Blood pressure, stroke, and coronary heart disease Part 2, short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context , 1990, The Lancet.

[50]  J. Cleeman,et al.  The National Cholesterol Education Program. , 1989, Clinics in laboratory medicine.

[51]  D. Betteridge,et al.  Strategies for reducing coronary heart disease and desirable limits for blood lipid concentrations: guidelines of the British Hyperlipidaemia Association. , 1987, British medical journal.

[52]  C. Lenfant,et al.  National High Blood Pressure Education Program. , 1986, Journal of the American Optometric Association.

[53]  R. Peto,et al.  Beta blockade during and after myocardial infarction: an overview of the randomized trials. , 1985, Progress in cardiovascular diseases.

[54]  L. Wilkins.  Guidelines for the treatment of mild hypertension: memorandum from a WHO/ISH meeting. , 1983, Bulletin of the World Health Organization.

[55]  R. Lindeman,et al.  Effects of treatment in hypertension. Results of a controlled study. , 1966, Journal of chronic diseases.

[56]  L. Cady,et al.  CORONARY HEART DISEASE A PROSPECTIVE STUDY , 1964 .

[57]  J. Cornfield.  Joint dependence of risk of coronary heart disease on serum cholesterol and systolic blood pressure: a discriminant function analysis. , 1962, Federation proceedings.

[58]  I. Page,et al.  The Effectiveness of Long‐Term Treatment of Malignant Hypertension , 1958, Circulation.

[59]  W. Elliott.  Cardiovascular disease prevention with a multidrug regimen in the developing world: a cost-effectiveness analysis , 2007 .

[60]  Combination Pharmacotherapy.  Combination Pharmacotherapy for Cardiovascular Disease , 2005, Annals of Internal Medicine.

[61]  S. Yusuf.  MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial. Commentary , 2002 .

[62]  S. Yusuf,et al.  Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000;342:145-53. , 2000 .

[63]  A. Richards,et al.  Management of raised blood pressure in New Zealand. , 1993, The New Zealand medical journal.

[64]  K. Anderson,et al.  Cardiovascular disease risk profiles. , 1991, American heart journal.

[65]  Guidelines for the detection of high-risk lipoprotein profiles and the treatment of dyslipoproteinemias. Canadian Lipoprotein Conference Ad Hoc Committee on Guidelines for Dyslipoproteinemias. , 1990, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[66]  Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. , 1967, JAMA.