“De-Risking” Risk Reduction: Should Coronary Artery Calcium Scoring Be the Gatekeeper to Preventive Pharmacotherapy With the Polypill?∗

The cardiovascular disease (CVD) epidemic remains the leading cause of death worldwide . Widespread adoption of the Western diet and lifestyle by populations in emergent countries with low or middle income has resulted in dramatic increases in the incidence of coronary heart disease and stroke. An overwhelming proportion of the cardiovascular risk is explained by the cumulative presence of classic and potentially modifiable risk factors, and this effect does not seem to be influenced by sex, ethnicity, or geography . Therefore, to effectively reduce risk and improve outcomes, prevention strategies should be conducted and implemented at the population level. Yet in 2003, Wald and Law introduced the concept of preventive pharmacotherapy as an attractive, but controversial, weapon to beat the CVD epidemic. According to most optimistic calculations, the implementation of a strategy based on preventive pharmacotherapy in subjects age ≥55 years, without known but at moderate risk of CVD, would result in 60% to 90% reduction in coronary heart disease events and 48% to 80% reduction in stroke rates . Unfortunately, hard data on the actual risk reduction that is associated with preventive pharmacotherapy using the polypill are presently still lacking.
Source: Journal of the American College of Cardiology - Category: Cardiology Authors: Tags: Cardiometabolic Risk: Editorial Comment Source Type: research