CNIC-复方药在西班牙真实二级预防患者中降低复发性主要心血管事件：NEPTUNO 研究。
The CNIC-Polypill reduces recurrent major cardiovascular events in real-life secondary prevention patients in Spain: The NEPTUNO study.
机构信息
Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain; CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), Madrid, Spain; IDIS (Instituto de Investigación Sanitaria de Santiago de Compostela), Santiago de Compostela, Spain.
CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), Madrid, Spain; Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain.
出版信息
Int J Cardiol. 2022 Aug 15;361:116-123. doi: 10.1016/j.ijcard.2022.05.015. Epub 2022 May 13.
BACKGROUND
To evaluate the effectiveness of a cardiovascular polypill including aspirin, ramipril and atorvastatin (CNIC-Polypill), on the incidence of recurrent major cardiovascular events (MACE) and risk factor control in patients with established atherosclerotic cardiovascular disease (ASCVD) vs different pharmacological therapeutic strategies.
METHODS
Retrospective, observational study using data from electronic-health records. Patients were distributed into 4 different cohorts: CNIC-Polypill (case cohort) vs 3 control cohorts: same monocomponents taken separately (Monocomponents), equipotent drugs (Equipotent) and other drugs not included in the previous cohorts (Other therapies). Patients were followed for 2 years or until MACE or death.
RESULTS
After propensity score matching, a total of 6456 patients (1614 patients per cohort) were analysed. After 2 years, the risk of recurrent MACE was lower in the CNIC-Polypill cohort compared to the control groups (22%; p = 0.017, 25%; p = 0.002, 27%; p = 0.001, higher in the Monocomponents, Equipotent and Other therapies cohorts, respectively). The incremental proportion of patients who achieved blood pressure (BP) and low-density lipoprotein cholesterol (LDLc) control from baseline was higher in the CNIC-Polypill cohort vs control cohorts (BP controlled patients: +12.5% vs + 6.3%; p < 0.05, +2.2%; p < 0.01, +2.4%; p < 0.01, LDLc controlled patients: +10.3% vs + 4.9%; p < 0.001, +5.7%; p < 0.001, +4.9%; p < 0.001, respectively). Medication persistence was higher in patients treated with the CNIC-Polypill (72.1% vs 62.2%, 60.0% and 54.2%, respectively; p < 0.001) at study end.
CONCLUSIONS
In secondary prevention patients, compared with control groups, treatment with the CNIC-Polypill was associated with significant reductions in the accumulated incidence of recurrent MACE, improved BP and LDLc control rates, and increased medication persistence.
背景
评估包括阿司匹林、雷米普利和阿托伐他汀的心血管复方药（CNIC-复方药）在有明确动脉粥样硬化性心血管疾病（ASCVD）的患者中与不同的药物治疗策略相比，对复发性主要心血管事件（MACE）的发生率和危险因素控制的有效性。
方法
使用电子健康记录中的数据进行回顾性、观察性研究。患者被分为 4 个不同的队列：CNIC-复方药（病例队列）与 3 个对照组：分别服用相同的单一组分（单一组分）、等效药物（等效药物）和未包括在前几个队列中的其他药物（其他治疗）。患者随访 2 年或直至发生 MACE 或死亡。
结果
经过倾向评分匹配，共分析了 6456 名患者（每个队列 1614 名患者）。2 年后，CNIC-复方药组的复发性 MACE 风险低于对照组（22%；p=0.017，25%；p=0.002，27%；p=0.001，分别为单一组分、等效药物和其他治疗组更高）。CNIC-复方药组与对照组相比，从基线开始血压（BP）和低密度脂蛋白胆固醇（LDLc）控制的患者比例增加（BP 控制患者：+12.5%对+6.3%；p<0.05，+2.2%；p<0.01，+2.4%；p<0.01，LDLc 控制患者：+10.3%对+4.9%；p<0.001，+5.7%；p<0.001，+4.9%；p<0.001）。研究结束时，接受 CNIC-复方药治疗的患者药物维持率更高（72.1%对 62.2%、60.0%和 54.2%；p<0.001）。
结论
在二级预防患者中，与对照组相比，CNIC-复方药治疗与复发性 MACE 累积发生率的显著降低、血压和 LDLc 控制率的提高以及药物维持率的增加相关。
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