Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Optimizing treatment benefit: individualized therapy or the polypill?

Nature Reviews Cardiology volume 11, page 307 (2014)Cite this article

Subjects

Access through your institution
Buy or subscribe

In their News & Views commentary, Webster and Rodgers address the controversy surrounding the use of the polypill in patients with cardiovascular disease (Webster, R. & Rodgers, A. Prevention: Coronary artery calcium and polypill therapy. Nat. Rev. Cardiol. 11, 7–8 [2014]).1 On the basis of data from the Multi-Ethnic Study of Atherosclerosis (MESA),2 they propose that patients most likely to benefit from prophylactic therapy can be identified using the coronary artery calcium (CAC) score. In MESA, patients with a CAC score of 0 had a very low event rate, and the authors of the MESA report suggest that treatment might be unnecessary in these individuals, thereby reducing the number of individuals considered for polypill therapy.1,2

Tailored therapy with preventive cardiovascular drugs has been extensively studied. Since the advent of the polypill concept, attitudes to this approach have diverged widely. Some physicians favour the use of a single polypill, which could increase patient compliance by simplifying drug intake. Whereas others are against the use of the polypill, because the ability to control the potential adverse effects of the individual drug components can be lost. Webster and Rodgers should have addressed this issue in more detail in their commentary,1 especially given that the effect of each drug, a patient's characteristics, and their response to the drug are unique. The variation in drug response between individuals is well known, in terms of both pharmacokinetic and pharmacodynamic effects. This point is illustrated by our analysis of angiotensin-converting-enzyme (ACE) inhibitors as an example of tailoring therapy to those patients most likely to benefit rather than 'group therapy' with a polypill.3,4,5

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Webster, R. & Rodgers, A. Prevention: Coronary artery calcium and polypill therapy. Nat. Rev. Cardiol. 11, 7–8 (2014).

    Article  CAS  Google Scholar 

  2. Bittencourt, M. S. et al. Polypill therapy, subclinical atherosclerosis, and cardiovascular events—implications for the use of preventive pharmacotherapy: MESA (Multi-Ethnic Study of Atherosclerosis). J. Am. Coll. Cardiol. 63, 434–443 (2014).

    Article  Google Scholar 

  3. Brugts, J. J. et al. Genetic determinants of treatment benefit of the angiotensin-converting enzyme-inhibitor perindopril in patients with stable coronary artery disease. Eur. Heart J. 31, 1854–1864 (2010).

    Article  CAS  Google Scholar 

  4. Wu, H. et al. Genetic variation and gender determine bradykinin type 1 receptor responses in human tissue: implications for the ACE-inhibitor-induced effects in patients with coronary artery disease. Clin. Sci. (Lond.) 126, 441–449 (2014).

    Article  CAS  Google Scholar 

  5. Fox, K. M. for the EUROPA trial investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 362, 782–788 (2003).

    Article  CAS  Google Scholar 

  6. Brugts, J. J. et al. The consistency of the treatment effect of an ACE-inhibitor based treatment regimen in patients with vascular disease or high risk of vascular disease: a combined analysis of individual data of ADVANCE, EUROPA, and PROGRESS trials. Eur. Heart J. 30, 1385–1394 (2009).

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Erasmus MC Thoraxcenter, 's gravendijkwal 230, Rotterdam, Netherlands

    Jasper J. Brugts

Authors
  1. Jasper J. Brugts
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Jasper J. Brugts.

Ethics declarations

Competing interests

The author declares no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brugts, J. Optimizing treatment benefit: individualized therapy or the polypill?. Nat Rev Cardiol 11, 307 (2014). https://doi.org/10.1038/nrcardio.2013.185-c1

Download citation

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/nrcardio.2013.185-c1

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing