The CNIC-Polypill reduces recurrent major cardiovascular events in real-life secondary prevention patients in Spain: The NEPTUNO study. (15th August 2022)

• Record Type: Journal Article
• Authors: González-Juanatey, José R.; Cordero, Alberto; Castellano, José Mª.; Masana, Luis; Dalmau, Regina; Ruiz, Emilio; Sicras-Mainar, Antonio; Fuster, Valentín
• Is Part Of: International journal of cardiology. Volume 361(2022)
• Page Start: 116
• Page End: 123
• Publication Date: 2022-08-15
• Subjects: Blood pressure -- Cardiovascular events -- CNIC-Polypill -- LDL-cholesterol -- MACE -- Secondary prevention; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.05.015
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: 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. Highlights: In secondary prevention patients the occurrence of new CV events is common. The CNIC-Polypill contains ASA 100 mg, atorvastatin 20/40 mg and ramipril 2.5/5/10 mg. The CNIC-Polypill reduces recurrent MACE in secondary prevention. The CNIC-Polypill improves BP, lipids and medication persistence.