De cardiovasculaire polypil voor hoogrisicopatiënten

Conflict of interest: M. Lafeber, W. Spiering, M. Bots and D. Grobbee participate in research into the effects of the polypill financed by Welcome Trust, the European Union and ZonMw. M. Bots gives lectures on risk stratification for Astra-Zeneca. F. Visseren receives research funding from Merck, ZonMw and Catharijnestichting Utrecht and speakers fees from Merck, AstraZeneca and Genzyme. Financial support: none declared.

• The initial theoretical concept of a polypill was a fixed-dosed combination pill containing an antiplatelet agent, a cholesterol-lowering agent and multiple blood pressure-lowering agents aimed at the prevention of atherosclerotic vascular disease in the population aged 55 years and up. The reduction in the risk of cardiovascular disease does not depend on the cholesterol level and blood pressure at the start of treatment.

• The pharmacological reduction in risk factors in individuals with a high risk of atherosclerotic vascular disease is often suboptimal, partly due to the complexity of the guidelines and low adherence to the therapy. A polypill may offer opportunities for improvement.

• Research has shown that the use of combination products leads to a greater reduction in risk factors than the use of separate substances, possibly through improved adherence to the therapy.

• The use of a polypill in the prevention of vascular disease in high-risk patients may lead to a more effective reduction in risk, a decrease in costs and a reduction in pharmacological expenditure.