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Inicio Medicina Clínica (English Edition) Consensus document for the use of the Polypill in the secondary prevention of ca...
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Vol. 148. Issue 3.
Pages 139.e1-139.e15 (February 2017)
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Vol. 148. Issue 3.
Pages 139.e1-139.e15 (February 2017)
Consensus statement
DOI: 10.1016/j.medcle.2016.10.047
Consensus document for the use of the Polypill in the secondary prevention of cardiovascular disease
Documento de consenso del uso clínico de la Polypill en la prevención secundaria del riesgo cardiovascular
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José Ramón González-Juanateya,
Corresponding author
, José María Mostazab, José María Lobosc, Benjamín Abarcad, José Luis Llisterrie, Gonzalo Baron-Esquiviasa, Enrique Galvea, Rosa María Lidóna, Francisco Xavier Garcia-Molla, Pedro Luis Sáncheza, Carmen Suárezb, Jesús Millánb, Vicente Pallarese, José Juan Alemánc, Isabel Egocheagad
a Sociedad Española de Cardiología, Madrid, Spain
b Sociedad Española de Medicina Interna, Madrid, Spain
c Sociedad Española de Medicina de Familia y Comunitaria, Barcelona, Spain
d Sociedad Española de Médicos Generales y de Familia, Madrid, Spain
e Sociedad Española de Médicos de Atención Primaria, Madrid, Spain
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Tables (11)
Table 1. Levels of evidence and degrees of recommendation (SIGN).
Table 2. Levels of scientific evidence and recommendations for questions on diagnosis.
Table 3. Recommendations on the determinants of lack of therapeutic adherence and recommendations on the actions to measure adherence.
Table 4. Recommendations on actions to optimize adherence to therapy.
Table 5. Results of therapeutic adherence in fixed-dose combination therapies.
Table 6. Recommendations on the use of fixed-dose combination therapies.
Table 7. Recommendations on the timing of Polypill prescription.
Table 8. Profile of high or very high risk patients with subclinical cardiovascular disease.
Table 9. Recommendations on replacing drugs by the Polypill ingredients.
Table 10. Recommendations on the administration of Polypill.
Table 11. Recommendations on lifestyle habits and behaviors in patients treated with the Polypill.
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Abstract

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.

Keywords:
Cardiovascular disease
Prevention
Adherence
Recommendations
Combination therapy
Polypill
Resumen

La enfermedad cardiovascular suele estar en fase avanzada cuando aparecen los primeros síntomas. El hecho de que la presentación clínica inicial pueda ser letal o altamente incapacitante enfatiza la necesidad de la prevención primaria y secundaria. Se estima que la proporción de pacientes con buena adherencia en prevención secundaria de la enfermedad cardiovascular es baja y disminuye progresivamente en el tiempo. La Polypill para la prevención cardiovascular secundaria es el primer tratamiento combinado en dosis fija de ácido acetilsalicílico, atorvastatina y ramipril aprobada en España. El propósito de este documento de consenso fue definir y recomendar, a través de la evidencia en la literatura y la opinión clínica de expertos, el impacto de la adherencia al tratamiento de prevención cardiovascular secundaria y el uso en la práctica clínica de la Polypill integrado en una estrategia global que incluye modificaciones en el estilo de vida. Para la realización de este consenso se ha utilizado la metodología RAND/UCLA que está basada en la evidencia científica y en el juicio colectivo y experiencia clínica de un panel de expertos. Como resultado se ha elaborado un informe final de recomendaciones sobre el impacto de la falta de adherencia al tratamiento de la prevención cardiovascular secundaria y el efecto del uso de una Polypill en la adherencia terapéutica de los pacientes. Las recomendaciones de este documento se orientan a todos aquellos especialistas, cardiólogos, médicos internistas y médicos de atención primaria con competencia en la prescripción y seguimiento de los pacientes de alto y muy alto riesgo cardiovascular y que requieran prevención secundaria.

Palabras clave:
Enfermedad cardiovascular
Prevención
Adherencia
Recomendaciones
Tratamiento combinado
Polypill

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