Key result
In patients with established ASCVD, the CNIC-Polypill was associated with a lower risk of recurrent MACE compared to monocomponents (22% higher risk in controls; p=0.017) and other therapies.
Why the study?
To evaluate the effectiveness of the CNIC-Polypill on recurrent major cardiovascular events and risk factor control in patients with established ASCVD compared with different pharmacological therapeutic strategies.
Does a cardiovascular polypill (aspirin, ramipril, atorvastatin) reduce recurrent major cardiovascular events in patients with established ASCVD compared to separate monocomponents or other therapies?
Observational (n=6,456)
Does a cardiovascular polypill (aspirin, ramipril, atorvastatin) reduce recurrent major cardiovascular events in patients with established ASCVD compared to separate monocomponents or other therapies?
In real-world secondary prevention, a polypill containing aspirin, ramipril, and atorvastatin significantly reduces recurrent MACE and improves medication adherence and risk factor control compared to multi-pill regimens.
Supports polypill evaluation in ASCVD secondary prevention; leaves open need for RCTs before practice change.
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.
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González‐Juanatey et al. (2022) conducted an observational in Established atherosclerotic cardiovascular disease (ASCVD) (n=6,456). CNIC-Polypill (aspirin, ramipril, and atorvastatin) vs. Monocomponents, equipotent drugs, and other therapies was evaluated on Recurrent major cardiovascular events (MACE) (p=0.017 (vs Monocomponents), 0.002 (vs Equipotent), 0.001 (vs Other therapies)). In patients with established ASCVD, the CNIC-Polypill was associated with a lower risk of recurrent MACE compared to monocomponents (22% higher risk in controls; p=0.017) and other therapies.
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