Castellano José M, Fuster Valentín, Jennings Catriona, Prescott Eva, Bueno Héctor
1 Centro Nacional de Investigaciones Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain.
2 Centro Integral de Enfermedades Cardiovasculares (CIEC), Hospital Universitario Montepríncipe, HM Hospitales, Madrid, Spain.
Eur J Prev Cardiol. 2017 Jun;24(3_suppl):44-51. doi: 10.1177/2047487317707324.
In 2011, for the first time in the history of humankind, non-communicable diseases became the leading cause of death worldwide. This change in trend is obviously multifactorial and very complex, as it is the paradoxical result of social, economic and health system growth worldwide. Vaccination and infectious diseases control, changing dietary habits worldwide, sedentary behaviour, globalisation, industrialisation (resulting in a shift from manual to sedentary labour), tobacco and sugary beverage surges in low- and middle-income countries and rapid urbanisation have all played a role in this epidemic transition. At the same time, the increase in cardiovascular risk factors, together with a decline in mortality in high-income countries in the past two decades, has led to a significant upsurge in the prevalence of secondary prevention of ischaemic heart disease. With this, the effect that non-adherence to cardioprotective drugs is having has become progressively clear, both in terms of clinical outcomes and as a driver of increased healthcare expenditure. The cardiovascular polypill, which was originally proposed as a strategy to improve accessibility to cardioprotective drugs worldwide, has proven to be a mainstay therapeutic approach for improving medication adherence in cardiovascular disease. In the current paper, we aim to review the need for a polypill strategy in the present scenario of cardiovascular disease, the available data that support such a strategy and the various clinical trials that are in progress that will help further shape future indications for the cardiovascular polypill.
2011年，非传染性疾病首次成为全球主要死因，这在人类历史上尚属首次。这种趋势变化显然是多因素且极为复杂的，是全球社会、经济和卫生系统发展带来的矛盾结果。疫苗接种和传染病防控、全球饮食习惯的改变、久坐不动的生活方式、全球化、工业化（导致从体力劳动转向久坐工作）、低收入和中等收入国家烟草和含糖饮料消费量激增以及快速城市化，都在这一疾病流行转变中发挥了作用。与此同时，心血管危险因素增加，加上过去二十年高收入国家死亡率下降，导致缺血性心脏病二级预防的患病率显著上升。由此，不坚持服用心脏保护药物所产生的影响，在临床结果和推动医疗保健支出增加方面都日益明显。最初作为一种提高全球心脏保护药物可及性的策略而提出的心血管复方制剂，已被证明是提高心血管疾病用药依从性的主要治疗方法。在本文中，我们旨在探讨在当前心血管疾病情况下采用复方制剂策略的必要性、支持该策略的现有数据以及正在进行的各种临床试验，这些试验将有助于进一步明确心血管复方制剂未来的适用症。
