1. Are we prescribing drugs in order to get the maximum adherence?
No. So this paper missed the actual issue.
What do I do with the medical treatment of patients with atheroma?
2. In primary prevention the debate is not over.
If the patient is at low risk (which is different from LDL Cholesterol status) the three pillars are not drugs
- stop smoking
- exercise, walk run swim bike and move yourself
- eat med diet at least.
If the patient is at high risk (genetic or metabolic or anything else as high Lpa ...) I will customize the treatment and probably use an appropriate dose of statins and antihypertensive drugs wisely...
3 In secondary prevention I will use the statin which is the most efficient (id est Atorvastatin in stroke and TIA, probably rosuvastatin in CAD), I will choose another statin in case of complications etc. And in this setting I will be more precise about antiplatelet therapy especially if there is a recurrence on aspirin or clopidogrel.
Eventually for all patients I will be careful with antihypertensive drugs because in those with mild hypertension polypill with two drugs could lead to hypotension.
So for those excellent reasons I will not use the polypill that fits all.