Grigorian-Shamagian Lilian, Coca Antonio, Morais Joao, Perez-Martinez Pablo
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón and Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
BMC Proc. 2023 Aug 17;17(Suppl 8):20. doi: 10.1186/s12919-023-00268-9.
Although the cardiovascular (CV) polypill concept is not new and several guidelines state that a CV polypill should be considered an integral part of a comprehensive CV disease (CVD) prevention strategy, there are still some barriers to its implementation in the real-world setting, mainly in secondary CV prevention. As the CNIC-polypill is the only one approved for secondary CV prevention in patients with atherosclerotic CVD in 27 countries worldwide, a panel of four discussants and 30 participants from 18 countries conveyed in a virtual meeting on April 21, 2022, to discuss key clinical questions regarding the practical use of the CNIC-Polypill and barriers to its implementation.Data presented showed that, although the use of the CV polypill is not explicitly mentioned in the current 2021 European Society of Cardiology guidelines on CVD prevention, it may be used in any patient for secondary CVD prevention tolerating all their components to improve outcomes through different aspects. The favourable results of the Secondary Prevention of Cardiovascular Disease in the Elderly (SECURE) trial now reinforce this recommendation. The panellists presented algorithms on how to switch from any baseline regimen when starting treatment with the CNIC-polypill in different situations, including patients with hypertension, dyslipidaemia, and a previous CV event; at discharge after a cardiovascular event; in chronic ischemic conditions; and in cases of polypharmacy. The panellists and expert discussants did agree that available studies conducted so far with the CNIC-polypill demonstrate that it is as efficacious as the monocomponents, equipotent drugs, or other therapies; reduces the risk of experiencing recurrent major CV events; improves medication adherence; reduces health care costs and resources compared to patients treated with loose drugs; and the patients prefer it over the multipill strategy.In conclusion, the data presented by the participants provided the evidence behind the use of the CNIC-polypill to help fulfil the goal of encouraging its adoption by physicians.
尽管心血管（CV）多效药丸的概念并不新鲜，且多项指南指出，CV多效药丸应被视为心血管疾病（CVD）综合预防策略的一个组成部分，但在现实环境中，其实施仍存在一些障碍，主要体现在二级CV预防方面。由于CNIC多效药丸是全球27个国家唯一获批用于动脉粥样硬化性CVD患者二级CV预防的药物，2022年4月21日，来自18个国家的4名讨论小组成员和30名参与者通过虚拟会议，讨论了有关CNIC多效药丸实际应用的关键临床问题及其实施障碍。所展示的数据表明，尽管2021年欧洲心脏病学会当前的CVD预防指南中未明确提及使用CV多效药丸，但它可用于任何能耐受其所有成分的二级CVD预防患者，以从不同方面改善预后。老年人心血管疾病二级预防（SECURE）试验的良好结果进一步强化了这一建议。小组成员介绍了在不同情况下开始使用CNIC多效药丸治疗时，如何从任何基线治疗方案转换的算法，这些情况包括高血压、血脂异常和既往有CV事件的患者；心血管事件后的出院时；慢性缺血性疾病；以及多重用药的情况。小组成员和专家讨论者一致认为，迄今为止对CNIC多效药丸进行的现有研究表明，它与单一成分药物、等效药物或其他疗法一样有效；可降低复发性重大CV事件的风险；提高用药依从性；与使用单一药物治疗的患者相比，可降低医疗保健成本和资源消耗；而且患者比多药丸策略更喜欢它。总之，参与者展示的数据为使用CNIC多效药丸提供了依据，有助于实现鼓励医生采用该药的目标。
