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Invited Commentary
Less Is More
December 2015

Targeting Vascular Risk Factors in Older Adults: From Polypill to Personalized Prevention

Author Affiliations
  • 1Division of Geriatric Medicine and Cardiology, Department of Experimental and Clinical Medicine, University of Florence and Careggi Teaching Hospital, Florence, Italy
JAMA Intern Med. 2015;175(12):1949-1950. doi:10.1001/jamainternmed.2015.5941

For many years vascular disease prevention strategies have been focused on reducing undertreatment, often using a “one-size-fits-all” approach to increase patient adherence. The paradigm of this approach has been the proposal of a polypill targeting multiple vascular risk factors, a standard treatment aimed at maximizing vascular protection. Conversely, during recent years an increasing emphasis has been placed on the issue of potential overtreatment, frequently resulting from the same treatment approach in all patients despite significant individual differences in comorbidity and life expectancy. In type 2 diabetes mellitus (T2DM), data from randomized clinical trials1 have shown uncertain or negative benefit-risk trade-offs associated with aggressive treatment of hypertension and hyperglycemia. These results, added to the well-known exclusion of elderly individuals with multiple morbidities from nearly all clinical trials, have informed recent guidelines, which now recommend more moderate targets for treatment of T2DM and hypertension in older participants, especially those considered frail or affected by important comorbidities.1