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Management verschiedener kardiovaskulärer Risikofaktoren mit einem Kombinationspräparat („Polypill“)

Management of different cardiovascular risk factors with a combination tablet (polypill)

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Zusammenfassung

Hintergrund

Die multifaktorielle Genese kardiovaskulärer Erkrankungen hat in der Primär- und Sekundärprophylaxe zur Polypharmazie mit evidenzbasierten Therapeutika wie Statinen, Antihypertensiva und Thrombozytenhemmern geführt. Die Anzahl verschriebener Phamaka korreliert umgekehrt mit der Adhärenz, was die Effektivität der Therapie beeinträchtigen kann. Fixe Kombinationspräparate („Polypill“) könnten die Adhärenz der Patienten steigern und damit kardiovaskulären Ereignissen vorbeugen.

Methoden

Literaturrecherche in Medline (via PubMed) und The Cochrane Library sowie der Studiendatenbank ClinicalTrials.gov.

Ergebnisse

In den bisher durchgeführten Studien zur kardiovaskulären Primärprävention zeigt die Polypill eine überlegene Kontrolle der Risikofaktoren (Hypertonie, „Low-density-lipoprotein“-Cholesterin [LDL-C]) gegenüber Placebo und gegenüber einer Standardtherapie aus Einzelpräparaten mindestens eine Nichtunterlegenheit. In der Sekundärprävention zeigen Kombinationspräparate vorwiegend Vorteile bei nichtadhärenten Patienten bezüglich Blutdruckkontrolle und Reduktion der LDL-C-Konzentration. Der Nachweis, dass die Polypill die kardiovaskuläre Morbidität und Mortalität gegenüber einer Standardtherapie absenkt, steht aus.

Schlussfolgerung

Kombinationspräparate sind nach Risiko-Nutzen-Einschätzung als Alternative zur Polypharmazie, insbesondere bei nichtadhärenten Patienten in Erwägung zu ziehen. Inwieweit durch die erwiesene Senkung der Risikofaktoren kardiovaskuläre Ereignisse verhindert werden können, ist Gegenstand laufender Untersuchungen. Limitiert sind die gegenwärtigen Polypills durch eine zu geringe Auswahl an Dosierungen der Einzelwirkstoffe, um eine Über- und Untertherapie in der individuellen Behandlung zu vermeiden.

Abstract

Background

The multifactorial origin of cardiovascular diseases has led to polypharmacy in primary and secondary prophylaxis with evidence-based medications, such as statins, antihypertensive drugs and platelet aggregation inhibitors. The number of prescribed drugs correlates inversely to adherence and can lead to treatment failure. Fixed-dose combination drugs (polypills) could increase the medication adherence of patients, reduce risks and prevent cardiovascular events.

Methods

This review is based on publications that were retrieved from Medline (via PubMed) and The Cochrane Library. The clinical database ClinicalTrials.gov. was also considered.

Results

In the studies on primary prevention conducted to date, fixed-dose combinations showed a superior control of risk factors, e.g. hypertension and low-density lipoprotein (LDL) cholesterol compared to placebo and at least non-inferiority compared to usual care. In secondary prevention, the effect of the polypill is mostly on the reduction of blood pressure and LDL cholesterol in non-adherent patients; however, evidence that fixed-drug combinations reduce cardiovascular morbidity and mortality compared to standard therapy is lacking.

Conclusion

The polypill can be considered as an alternative to polypharmacy after a risk-benefit assessment, especially in non-adherent patients. Ongoing studies are investigating the effect of the polypill on cardiovascular events. Current polypills are limited by the lack of sufficient dosages of the individual components to avoid overtreatment and undertreatment at the individual treatment level.

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Author information

Authors and Affiliations

  1. Institut für Pharmakologie und Präventive Medizin, Mahlow, Deutschland

    P. Bramlage & G. van Mark

  2. Medizinische Klinik V (Nephrologie, Hypertensiologie, Rheumatologie, Endokrinologie, Diabetologie), Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland

    W. März &  B. K. Krämer

  3. Klinisches Institut für Medizinische und Chemische Labordiagnostik, Medizinische Universität Graz, Graz, Österreich

    W. März

  4. Synlab Akademie, synlab Holding Deutschland GmbH, Mannheim und Augsburg, Deutschland

    W. März

  5. Klinik und Poliklinik für Allgemeine und Interventionelle Kardiologie, Universitätsklinikum Eppendorf, Hamburg, Deutschland

    D. Westermann PD

  6. Universitäres Herzzentrum Hamburg, Hamburg, Deutschland

    D. Westermann PD

  7. Institut für Sportwissenschaft, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland

    B. Weisser

  8. Kardiologische Gemeinschaftspraxis, Dinslaken, Deutschland

    J. H. Wirtz

  9. Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Deutschland

    U. Zeymer

  10. Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Deutschland

    U. Zeymer

  11. Medizinische Klinik I, Clemenshospital Münster, Akad. LKH der Universität Münster, Münster, Deutschland

    P. Baumgart

  12. Klinik für Innere Medizin III, Universitätsklinikum des Saarlands, Homburg/Saar, Deutschland

    U. Laufs

  13. CARIM School for Cardiovascular Diseases, Maastricht University, PO Box 616, 6200 MD, Maastricht, Niederlande

    T. Unger

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W. März ist Angestellter von Synlab Holding Deutschland GmbH. Er bekam Vortrags- und Beraterhonorare von den Firmen Aegerion Pharmaceuticals, Amgen, AstraZeneca, Danone Research, Sanofi, MSD, Synageva und Unilever. P. Bramlage bekam Beraterhonorare von den Firmen Aspen, AstraZeneca, Bayer Schering, Boston Scientific, Bristol Myers Squibb, Daiichi Sankyo, Edwards Lifesciences, Hexal, Merck, Novartis, Pfizer, Sanofi und Takeda. D. Westermann erklärt, dass er von einer Reihe von Firmen, die Antihypertensiva und Statine produzieren, Beratungs- und Vortragshonorare erhalten hat. B. Weisser erklärt, dass er von einer Reihe von Firmen, die Antihypertensiva und Statine produzieren, Beratungs- und Vortragshonorare erhalten hat. J.H. Wirtz erklärt, dass er von einer Reihe von Firmen, die Antihypertensiva und Statine produzieren, Beratungs- und Vortragshonorare erhalten hat. U. Zeymer erhielt Vortrags- und Beraterhonorare von den Firmen Aspen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Hexal, MSD, Novartis, Pfizer und Sanofi. P. Baumgart erklärt, dass er von einer Reihe von Firmen, die Antihypertensiva und Statine produzieren, Beratungs- und Vortragshonorare erhalten hat. B.K. Krämer bekam Vortrags- und/oder Beraterhonorare von den Firmen Amgen, Astellas, Bayer, BMS, Chiesi und Pfizer. T. Unger erhielt Vortrags- und Beraterhonorare von den Firmen Actelion, AstraZeneca, Bayer, Berlin-Chemie, Boehringer-Ingelheim, BMS, Daiichi Sankyo, Hexal, MSD, Novartis, Pfizer, Roche, Sanofi, Servier, Takeda und Vicore. G. van Mark und U. Laufs geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Bramlage, P., März, W., Westermann, D. et al. Management verschiedener kardiovaskulärer Risikofaktoren mit einem Kombinationspräparat („Polypill“). Herz 43, 246–257 (2018). https://doi.org/10.1007/s00059-017-4554-5

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  • DOI: https://doi.org/10.1007/s00059-017-4554-5

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