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Triple Combination Therapy for Global Cardiovascular Risk: Atorvastatin, Perindopril, and Amlodipine

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Abstract

Statins, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers (CCBs) have markedly changed the clinical progression of patients with coronary artery disease (CAD). The goal of this paper is to review the rationale and evidence for combining these three drug classes in hypertensive patients with hypercholesterolemia or CAD. Data sources include a literature search for publications on the use of a statin combined with various antihypertensive drugs in patients with hypertension and hypercholesterolemia or stable CAD. Hypercholesterolemia and hypertension constitute major physiological risk factors of ischemic heart disease. Current guidelines recommend a global approach to risk management, using agents that address as many risk factors as possible. Dual combination therapies are an important component of guideline-recommended therapy in hypertension. Our review of the literature indicates that triple therapy with a statin, ACE inhibitor, and CCB is associated with a significant reduction in major cardiovascular events. For example, a post hoc analysis in 1056 patients with stable CAD participating in the EUROPA trial indicated that the addition of perindopril to a CCB and a lipid-lowering agent was associated with a 46 % reduction in the composite of cardiovascular death, myocardial infarction, and resuscitated cardiac arrest (p = 0.023). In addition, single pill formulations are known to result in better adherence to the treatment. Single-pill formulations that combine a statin, an ACE inhibitor, and a CCB appear to offer an effective approach to the management of global cardiovascular risk.

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Fig. 1

Reproduced from Williams et al. [31] with permission

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Reproduced from Bertrand [37] with permission

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Reproduced from Sever et al. [55] with permission

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Acknowledgments

We thank Sarah Novack, PhD, who provided medical writing assistance, and participated in writing and technical editing of the manuscript.

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Authors and Affiliations

  1. Lille Heart Institute, 139 C-76 rue de Lille Lambersart, 59037, Lille, France

    Michel E. Bertrand

  2. 1st Cardiology Department, Athens Medical School, Athens, Greece

    Charalambos Vlachopoulos

  3. Hypertension Excellence Centre, CHU Avicenne-AP-HP, and Paris 13 University (EA 3412), Bobigny, France

    Jean-Jacques Mourad

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Medical writing assistance and statistical support were provided by Servier, France. No other sources of funding were used to assist with the preparation of this review.

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ME Bertrand has received honoraria for speaking at symposia and for consultation from Servier. J Mourad has received honoraria for consultation from Servier. C Vlachopoulos has received honoraria, research grants, or both, from Servier. The authors have no other relevant affiliations or financial involvement with any organization or entity in conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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Bertrand, M.E., Vlachopoulos, C. & Mourad, JJ. Triple Combination Therapy for Global Cardiovascular Risk: Atorvastatin, Perindopril, and Amlodipine. Am J Cardiovasc Drugs 16, 241–253 (2016). https://doi.org/10.1007/s40256-016-0175-2

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