Robinson Jennifer G, Maheshwari Nidhi
Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA.
Am J Cardiol. 2005 Feb 1;95(3):373-8. doi: 10.1016/j.amjcard.2004.09.036.
A "polypill" for the primary prevention of cardiovascular disease has been proposed. We estimated the projected benefit of a secondary prevention "poly-portfolio" strategy, including pharmacologic and lifestyle approaches for those with coronary heart disease (CHD) or stroke. Based on recent clinical trial results and clinical guidelines, combinations of a high-dose statin, low to standard doses of antihypertensive therapy, aspirin, omega-3 fish oil, cardiac rehabilitation, and diet were evaluated. Patients with CHD, post-myocardial infarction (MI), or stroke were projected to experience 84%, 91%, and 77% reductions, respectively, in CHD events from a pharmacologic approach. Numbers of those needed to treat (NNT) for 5 years were 9 to 11 to prevent 1 CHD event, and 21 to prevent 1 stroke. Post-MI patients were projected to experience a 93% reduction in the risk of CHD death (NNT 16) from a pharmacologic approach and a 97% reduction in the risk of CHD death (NNT 15) with the addition of lifestyle changes. A secondary prevention polyportfolio holds great promise for reducing the burden of cardiovascular disease in the highest risk patients.
有人提出了一种用于心血管疾病一级预防的“多效药丸”。我们估计了一种二级预防“综合策略”的预期益处，该策略包括针对冠心病（CHD）或中风患者的药物治疗和生活方式干预措施。基于近期的临床试验结果和临床指南，我们评估了高剂量他汀类药物、低至标准剂量的抗高血压治疗、阿司匹林、ω-3鱼油、心脏康复和饮食的联合应用。预计患有冠心病、心肌梗死（MI）后或中风的患者通过药物治疗，冠心病事件分别减少84%、91%和77%。预防1例冠心病事件5年所需治疗的人数（NNT）为9至11人，预防1例中风为21人。预计心肌梗死后患者通过药物治疗冠心病死亡风险降低93%（NNT为16），加上生活方式改变后冠心病死亡风险降低97%（NNT为15）。二级预防综合策略在降低高危患者心血管疾病负担方面具有巨大潜力。
