Di Fusco Stefania Angela, Matteucci Andrea, Spinelli Antonella, Fedele Silvio, Aquilani Stefano, Nardi Federico, Colivicchi Furio
U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma.
Unità di Cardiologia, Ospedale Sandro Pertini, Roma.
G Ital Cardiol (Rome). 2025 Jul;26(7 Suppl. 1):9-14. doi: 10.1714/4525.45246.
The use of polypill, a single pill containing more therapeutic agents, has shown to increase therapeutic adherence and improve cardiovascular prognosis. Among the several polypills currently available, the fixed dose combination of rosuvastatin at different doses and acetylsalicylic acid (ASA) at low dose represents a useful therapeutic option for cardiovascular disease prevention. When the impact of rosuvastatin in association with ASA on cardiovascular disease incidence has been compared with the combination of other statins with ASA, rosuvastatin plus ASA is the combination associated with the lowest incidence of several cardiovascular diseases. As regards the use of ASA in primary prevention, the global clinical benefit may be weakened by the occurrence of bleedings. Therefore, in primary prevention, the combination rosuvastatin/ASA may be considered when the bleeding risk is low and the cardiovascular risk is augmented. In secondary prevention, the need for an early optimal management of cholesterol control may require the use of a fixed dose combination of statin/ezetimibe and ASA in a separate formulation. However, in selected cases in which the distance from the therapeutic low-density lipoprotein cholesterol target does not require the combination of high efficacy statin with ezetimibe, the fixed dose combination rosuvastatin/ASA may be considered even in secondary prevention.
使用复方制剂(一种含有多种治疗药物的单一药丸)已显示可提高治疗依从性并改善心血管预后。在目前可用的几种复方制剂中,不同剂量的瑞舒伐他汀与低剂量乙酰水杨酸(ASA)的固定剂量组合是预防心血管疾病的一种有用治疗选择。当将瑞舒伐他汀与ASA联合使用对心血管疾病发病率的影响与其他他汀类药物与ASA的组合进行比较时,瑞舒伐他汀加ASA是与几种心血管疾病最低发病率相关的组合。关于ASA在一级预防中的使用,出血的发生可能会削弱总体临床益处。因此,在一级预防中,当出血风险低且心血管风险增加时,可以考虑使用瑞舒伐他汀/ASA组合。在二级预防中,早期优化胆固醇控制的需求可能需要使用他汀类药物/依折麦布和ASA的固定剂量组合,制成单独的剂型。然而,在某些情况下,如果距离治疗性低密度脂蛋白胆固醇目标的差距不需要高效他汀类药物与依折麦布联合使用,即使在二级预防中也可以考虑使用瑞舒伐他汀/ASA固定剂量组合。