González-Juanatey José Ramón, Mostaza José María, Lobos José María, Abarca Benjamín, Llisterri José Luis, Baron-Esquivias Gonzalo, Galve Enrique, Lidón Rosa María, Garcia-Moll Francisco Xavier, Sánchez Pedro Luis, Suárez Carmen, Millán Jesús, Pallares Vicente, Alemán José Juan, Egocheaga Isabel
Sociedad Española de Cardiología, Madrid, España.
Sociedad Española de Medicina Interna, Madrid, España.
Med Clin (Barc). 2017 Feb 9;148(3):139.e1-139.e15. doi: 10.1016/j.medcli.2016.10.031. Epub 2016 Dec 16.
Cardiovascular disease is a chronic disorder which is usually already at an advanced stage when the first symptoms develop. The fact that the initial clinical presentation can be lethal or highly incapacitating emphasizes the need for primary and secondary prevention. It is estimated that the ratio of patients with good adherence to secondary prevention of cardiovascular disease is low and also decreases gradually over time. The Polypill for secondary prevention of cardiovascular disease is the first fixed-dose combination therapy of salicylic acid, atorvastatin and ramipril approved in Spain. The purpose of this consensus document was to define and recommend, through the evidence available in the literature and clinical expert opinion, the impact of treatment adherence in the secondary prevention of cardiovascular disease and the use of the Polypill in daily clinical practice as part of a global strategy including adjustments in patient lifestyle. A RAND/UCLA methodology based on scientific evidence, as well as the collective judgment and clinical expertise of an expert panel was used for this assessment. As a result, a final report of recommendations on the impact of the lack of adherence to treatment of secondary prevention of cardiovascular disease and the effect of using a Polypill in adherence of patients was produced. The recommendations included in this document have been addressed to all those specialists, cardiologists, internists and primary care physicians with competence in prescribing and monitoring patients with high and very high cardiovascular risks.
心血管疾病是一种慢性疾病，通常在出现首发症状时就已处于晚期。初始临床表现可能致命或导致严重失能，这一事实凸显了一级和二级预防的必要性。据估计，心血管疾病二级预防依从性良好的患者比例较低，且会随着时间逐渐下降。用于心血管疾病二级预防的多效药丸是西班牙批准的第一种水杨酸、阿托伐他汀和雷米普利固定剂量联合疗法。本共识文件的目的是通过文献中的现有证据和临床专家意见，界定并推荐治疗依从性对心血管疾病二级预防的影响，以及在日常临床实践中使用多效药丸作为包括调整患者生活方式在内的全球战略的一部分。本评估采用了基于科学证据的兰德/加州大学洛杉矶分校方法，以及专家小组的集体判断和临床专业知识。结果，生成了一份关于心血管疾病二级预防治疗依从性不足的影响以及使用多效药丸对患者依从性的影响的最终建议报告。本文件中的建议针对所有在为心血管风险高和非常高的患者开处方和监测方面有能力的专科医生、心脏病专家、内科医生和初级保健医生。
