AUTHOR=Grigorian-Shamagian Lilian , Edel Klaus , Esteve-Pastor María Asunción , Aceña Álvaro , Silva Claudia , Delgado-Silva Joana , Ntaios Georges , Demerouti Eftychia , Brotons Carlos 

TITLE=Practical Decision Algorithms for the Use of the Cardiovascular Polypill in Secondary Prevention in Europe

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.663361

DOI=10.3389/fcvm.2021.663361

ISSN=2297-055X

ABSTRACT=The main objective of cardiovascular disease (CVD) prevention is to reduce premature morbidity and mortality. Despite recommendations on evidence-based pharmacological treatment and lifestyle changes, the control of CV risk factors such as hypertension or dyslipidaemia is not optimal. The use of a CV polypill, including guideline-recommended drugs, as a baseline therapy, may contribute to improving risk factors control by either improving the treatment adherence or by the synergistic effect of its components. The first CV polypill approved in Europe as an effective strategy for secondary prevention contains acetylsalicylic acid, atorvastatin (in two optional doses), and ramipril (in three optional doses) in a single pill. The present practical clinical document aims to provide a guide for patient management after an acute coronary syndrome (ACS) or with chronic cardiovascular disease (CCVD) with a strategy based on the CV polypill, considering also the need to add other therapies for a personalized treatment. The most suitable clinical scenarios for the CV polypill use are discussed: a) in patients after an ACS at discharge b) in patients with CCVD (chronic coronary syndrome, stroke, or peripheral artery disease) with uncontrolled low-density lipoprotein cholesterol (LDL-c) and/or blood pressure levels; and c) in patients with CCVD with well controlled risk factors to simplify treatment and reduce polypharmacy in the context of chronic CVD prevention.