Department of Medicine, Yale University, New Haven, Conn, USA.
Stroke. 2010 Oct;41(10 Suppl):S35-8. doi: 10.1161/STROKEAHA.110.592022.
The control of stroke risk factors remains challenging. The "polypill" concept represents a novel approach for reducing stroke and cardiovascular risk factors in the entire population. The polypill would include several components and be provided without prescription to all adults of a certain age.
A polypill aimed at lowering blood pressure and cholesterol levels is estimated to potentially reduce the risk of a first ischemic stroke by 53%; this would translate to about 400 000 fewer strokes each year in the United States alone. Recommending a polypill for the entire older adult population would, however, include many individuals without the multiple risk factors targeted by its components, putting them at risk for drug-related side effects and responsible for the costs of a medication from which they would not derive benefit. Additional arguments for and against the polypill approach are discussed.
Only clinical trials can provide the evidence needed to determine the usefulness of the polypill approach. Issues related to defining the components of the polypill, evaluating the pharmacodynamics and pharmacokinetics of a multiple-component formulation, and establishing safety and cost-effectiveness when given to large populations, however, are not trivial.
控制中风危险因素仍然具有挑战性。“复方药丸”概念代表了一种降低全人群中风和心血管危险因素的新方法。这种复方药丸将包含几种成分，并无需处方提供给一定年龄的所有成年人。
降低血压和胆固醇水平的复方药丸估计可以将首次缺血性中风的风险降低 53%；仅在美国，这每年就可减少约 40 万例中风。然而，建议所有老年成年人服用复方药丸将包括许多没有该药物成分所针对的多种危险因素的个体，使他们面临与药物相关的副作用风险，并承担他们无法从中获益的药物费用。讨论了支持和反对复方药丸方法的其他论点。
只有临床试验才能提供确定复方药丸方法有用性所需的证据。然而，确定复方药丸的成分、评估多成分制剂的药效学和药代动力学以及在大人群中给予时的安全性和成本效益等问题并非微不足道。
