CNIC 复方固定剂量制剂（阿司匹林+阿托伐他汀+雷米普利）在 2 型糖尿病患者心血管疾病二级预防中的应用：与其他治疗方法的对比分析。
The CNIC polypill (Acetylsalicylic acid + Atorvastatin + Rampril) in secondary prevention of cardiovascular disease in patients with type 2 diabetes: A comparative analysis with alternative therapeutic approaches.
机构信息
Cardiology Department, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Spanish Biomedical Research Centre in Cardiovascular Diseases (CIBERCV), Madrid, Spain; Foundation Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
Vascular Medicine and Metabolism Unit, Universitat Rovira i Virgili, Hospital Universitario Sant Joan, Reus, Spain; IISPV (Institut d'Investigació Sanitària Pere Virgili), Reus, Spain; CIBERDEM (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas), Madrid, Spain.
出版信息
Int J Cardiol. 2025 Jan 1;418:132578. doi: 10.1016/j.ijcard.2024.132578. Epub 2024 Sep 19.
BACKGROUND
Patients with type 2 DM (T2DM) and established cardiovascular disease (CVD) are at high risk of recurrent CV events. We analysed the use of the CNIC-polypill (acetylsalicylic acid, ramipril, and atorvastatin) compared with other therapeutic strategies in patients with T2DM and CVD from the retrospective NEPTUNO study.
METHODS
Patients were stratified into four therapeutic approaches: CNIC-polypill, its monocomponents as loose medications, equipotent medications, and other therapies. Outcomes included the 2-year cumulative incidence and risk of recurrent major adverse CV events (MACE) and CV death, risk factors control, medication persistence, and utilisation of healthcare resources and costs.
RESULTS
After two years, T2DM patients treated with Monocomponents, Equipotent drugs, or Other therapies had increased recurrent MACE risk compared to CNIC-polypill (11 %, 23 %, and 44 %, respectively; P < 0.05) and shorter median time to CV events (305-377 vs. 396 days; P < 0.05). The CNIC-polypill group achieved a significant 11.2 % increase in patients reaching LDL-c targets <70 mg/dL, outperforming other strategies. It also exhibited superior triglyceride control and a higher proportion achieving the <130/80 mmHg blood pressure goal. The CNIC-polypill cohort displayed significantly higher 24-month persistence (71.5 % vs. 54.7 %-58.3 %, p < 0.05) and lower mean adjusted costs per patient (€5083 vs. €6000-€6523; p < 0.05). In a comparative analysis, T2DM patients had lower baseline LDL-c and total cholesterol levels than non-T2DM counterparts yet experienced a higher incidence of recurrent MACE over two years.
CONCLUSION
The CNIC-polypill (ASA, atorvastatin and ramipril) emerged as a promising treatment for patients with CVD, particularly those with T2DM, offering improved clinical outcomes and economic efficiency.
背景
患有 2 型糖尿病（T2DM）和已确诊心血管疾病（CVD）的患者再次发生心血管事件的风险较高。我们分析了在回顾性 NEPTUNO 研究中，使用 CNIC-复方药（阿司匹林、雷米普利和阿托伐他汀）与其他治疗策略治疗 T2DM 和 CVD 患者的效果。
方法
患者分为四种治疗方法：CNIC-复方药、其单一药物、等效药物和其他疗法。结果包括两年内累积复发主要不良心血管事件（MACE）和心血管死亡的风险、危险因素控制、药物持续使用情况以及医疗资源和费用的使用情况。
结果
两年后，与 CNIC-复方药相比，使用单一药物、等效药物或其他疗法的 T2DM 患者复发 MACE 的风险增加（分别为 11%、23%和 44%；P<0.05），且发生心血管事件的中位时间更短（305-377 天与 396 天；P<0.05）。CNIC-复方药组 LDL-c 目标值<70mg/dL 的患者比例增加了 11.2%，显著优于其他策略。它还表现出更好的甘油三酯控制和更高比例的患者达到<130/80mmHg 的血压目标。CNIC-复方药组的 24 个月持续率显著更高（71.5%比 54.7%-58.3%，p<0.05），每位患者的平均调整成本也更低（5083 欧元比 6000-6523 欧元；p<0.05）。在一项比较分析中，与非 T2DM 患者相比，T2DM 患者的基线 LDL-c 和总胆固醇水平较低，但在两年内复发 MACE 的发生率较高。
结论
CNIC-复方药（ASA、阿托伐他汀和雷米普利）为 CVD 患者，特别是 T2DM 患者提供了一种有前景的治疗方法，可改善临床结果和经济效益。
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