复方药丸用于心血管疾病的一级预防。

Polypills for primary prevention of cardiovascular disease.

机构信息

Westmead Applied Research Centre (WARC), University of Sydney, Westmead, New South Wales, Australia.

Westmead Hospital, Westmead, New South Wales, Australia.

出版信息

Nat Rev Cardiol. 2019 Oct;16(10):602-611. doi: 10.1038/s41569-019-0209-y.

DOI:10.1038/s41569-019-0209-y

PMID:31150009

Abstract

Polypills can contain multiple pharmaceutical agents targeting the cardiovascular system. The use of polypills in the secondary prevention of cardiovascular disease (CVD) has received broad support; however, the use of polypills in the primary prevention of CVD is more controversial. This controversy stems from an inherent resistance to the medicalization of primary prevention, and the lower CVD event rate in this population means that smaller absolute benefits are derived. Indeed, drug-related adverse effects, such as from aspirin, might even outweigh the benefits. The role of fixed-dose combination (FDC) therapy for blood pressure (BP) lowering in combatting the widespread undertreatment of high BP - the leading modifiable risk factor contributing to the global burden of CVD - has gained momentum. Increasing evidence suggests that FDC pills containing multiple low doses of BP-lowering drugs produce more effective BP lowering than the use of fewer separate BP-lowering drugs at higher doses, without an increase in adverse effects. Trials of FDC pills comprising three half-dose or four quarter-dose BP-lowering drugs have shown substantial efficacy. In this Review, we summarize the current evidence on low-dose BP-lowering FDC pills and the justification for this approach in the context of polypills in the primary prevention of CVD.

摘要

复方片剂可以包含多种针对心血管系统的药物。复方片剂在心血管疾病（CVD）二级预防中的应用得到了广泛支持；然而，在 CVD 一级预防中的应用更具争议性。这种争议源于对一级预防医学化的固有抵制，以及该人群 CVD 事件发生率较低，意味着从中获得的绝对益处较小。事实上，药物相关的不良反应（如阿司匹林）甚至可能超过益处。固定剂量联合（FDC）疗法在降低血压（BP）方面的作用——降低高血压治疗不足的情况，高血压是导致 CVD 全球负担的主要可改变风险因素——已经引起了广泛关注。越来越多的证据表明，含有多种低剂量降压药物的复方片剂比使用更高剂量的较少数量的单一降压药物更能有效地降低血压，且不会增加不良反应。包含三种半剂量或四种四分之一剂量降压药物的 FDC 片剂试验显示出了显著的疗效。在这篇综述中，我们总结了目前关于低剂量降压 FDC 片剂的证据，并根据这一方法在 CVD 一级预防中复方片剂的背景下进行了论证。