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Polypill strategy at the heart of cardiovascular secondary prevention
  1. Borja Ibañez1,2,3,
  2. José M Castellano1,4,5,
  3. Valentin Fuster1,6
  1. 1Clinical Research Department, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
  2. 2Cardiology Department, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
  3. 3CIBERCV, CIBER de enfermedades Cardiovasculares, Madrid, Spain
  4. 4Centro Integral de Enfermedades Cardiovasculares (CIEC), Hospital Universitario Montepríncipe, HM Hospitales, Madrid, Spain
  5. 5Facultad de Medicina, Universidad CEU San Pablo, Madrid, Spain
  6. 6Cardiology Department, Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
  1. Correspondence to Dr Borja Ibañez, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) Madrid 28029 Spain ; bibanez{at}

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Over recent decades, cardiovascular disease (CVD) has overtaken infectious diseases as the leading cause of death worldwide.1 This shift is partly due to the great advances in the treatment of infectious diseases and the success of associated public health campaigns. General public awareness of the importance of both preventing high-risk exposure and early therapy initiation and adherence has helped reduce the burden of communicable (infectious) diseases. This contrasts sharply with the story of non-communicable diseases such as CVD. The incidence of atherosclerosis (the single largest underlying cause of CVD) has increased exponentially due to the immense lifestyle changes witnessed first in developed countries but lately also in low-income and middle-income countries. This rapid worldwide change in lifestyle has resulted in dramatic increases of obesity, sedentarism, dyslipidaemia and hypertension, all of which are risk factors for atherosclerosis.

The control of modifiable cardiovascular risk factors, such as lipid levels and blood pressure, has a clear impact in reducing the likelihood of experiencing a cardiovascular event, and this holds true for both primary and secondary prevention. The leading cardiovascular scientific societies dedicate major efforts to providing guidelines to enable clinicians to define specific targets for each of these modifiable factors based on a patient’s risk profile. The most recent European Society of Cardiology (ESC) ‘Guidelines on cardiovascular disease prevention in clinical practice’, released in 2016, established low-density lipoprotein (LDL) cholesterol targets of 70, 100 and 115 mg/dL for individuals at very high, high and low-to-moderate risk, respectively, and a blood pressure target of <140/90 mm Hg (140/85 mm Hg for most patients with diabetes).2 The identification of risk factors allows gross prediction of future cardiovascular events such as myocardial infarction (MI) and stroke.

Patients experiencing an acute cardiovascular event today have a high likelihood of surviving the episode thanks to the great therapeutic advances in MI and other acute …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests BI and VF have no personal conflicts of interest to declare. JMC has received speaker fees and travel support from Ferrer. The CNIC is a non-profit public institution that receives royalties for the sales of a polypill (Trinomia) composed of aspirin, ramipril and atorvastatin, but no CNIC researcher has direct interests or receives any personal benefits.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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