The middle-aged and older American: wrong prototype for a preventive polypill?

TitleThe middle-aged and older American: wrong prototype for a preventive polypill?
Publication TypeJournal Article
Year of Publication2005
AuthorsMulrow C, Kussmaul W
JournalAnnals of internal medicine
Date Published2005 Mar 15
KeywordsAge Factors, Coronary Disease, Drug Combinations, Humans, Life Style, Polypharmacy, Risk Factors, United States

Any way you look at them, the numbers are staggering. In the coming year, about 1.2 million Americans will have a first or recurrent coronary attack and about 700 000 will have a new or recurrent stroke (1) . Most Americans older than age 35 years have 1 or more vascular risk factors. More than one third of them have hypercholesterolemia (2) . One fifth of adult Americans smoke, and most have inactive lifestyles (3) . One third have high blood pressure, more than 30% are obese, and nearly 10% have diabetes (4) .

Americans have a dizzying array of options available to reduce vascular disease and its consequences. Preventive approaches aimed primarily at identifying and treating individual risk factors were popular in the 1980s and 1990s but had limited success. Social and environmental changes curbed some factors, such as smoking, but increased others, such as obesity and sedentary lifestyles. Treatment recommendations that targeted single risk factors were incomplete and contained discrepancies from guidelines targeting other risk factors (5) . There were no clear treatment thresholds for factors such as blood pressure, lipid levels, abdominal obesity, and physical activity. Although relative treatment benefits were proved similar for different levels of certain risk factors, absolute benefits were greatest with treatment of higher-risk persons. Optimal assessment of absolute risk required knowledge of multiple risk factors. Recognizing these issues, experts now recommend assessment of an individual's global risk for vascular disease when deciding whether to treat risk factors and selecting specific target levels for those risk factors. For example, recent recommended treatment thresholds and target levels for low-density lipoprotein cholesterol level vary depending on whether individuals have low, high, or very high risk for coronary heart disease (CHD) (6, 7). We hope but do not yet know if emphasis on global risk assessment …

Alternate JournalAnn. Intern. Med.
PubMed ID15767624
Email Newsletter icon, E-mail Newsletter icon, Email List icon, E-mail List icon
Get email updates
Recipes. upcoming classes.