Victoria Ros-Castelló, Elena Natera-Villalba, Ana Gómez-López, Arantxa Sánchez-Sánchez, Juan Luis Chico-García, Sebastian García-Madrona, Rocio Vera-Lechuga, Consuelo Matute-Lozano, Alicia de Felipe Mimbrera, Antonio Cruz-Culebras, Araceli Alonso-Canovas, Jaime Masjuan
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Studies focusing on cerebrovascular disease and real-life efficacy compared with conventional treatment are lacking.</p><p><strong>Methods: </strong>This is a retrospective, hospital-based cohort study of acute ischaemic stroke patients who were prescribed a polypill (aspirin 100 mg, atorvastatin 20/40 mg, ramipril 2.5/5/10 mg) versus conventional treatment (aspirin 100 mg and other blood pressure/lipid-lowering agents) in secondary prevention (2017-2018). Clinical records were reviewed 90 days after discharge for stroke recurrence, vascular risk factor control, and safety. Adherence was assessed using the adapted Morisky-Green scale.</p><p><strong>Results: </strong>A total of 104 patients were included (61% male; mean age 69.7 ± 13.9 years); 54 were treated with the polypill and 50 with conventional treatment. No baseline differences in clinical or demographic variables were detected. 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引用次数: 6
摘要
背景:使用心血管多药片，一种固定剂量的联合治疗，被认为可以提高依从性。然而，随机对照试验(RCTs)可能高估了它。目前还缺乏针对脑血管疾病的研究以及与常规治疗相比的实际疗效。方法:这是一项回顾性的、以医院为基础的队列研究，在2017-2018年，急性缺血性卒中患者在二级预防中服用复方药片(阿司匹林100 mg、阿托伐他汀20/40 mg、雷米普利2.5/5/10 mg)与常规治疗(阿司匹林100 mg和其他降血压/降脂药)。出院后90天回顾卒中复发、血管危险因素控制和安全性的临床记录。采用Morisky-Green量表评估依从性。结果:共纳入104例患者(61%为男性;平均年龄69.7±13.9岁);54例采用复方丸剂治疗，50例采用常规治疗。在临床或人口学变量方面没有发现基线差异。与常规治疗组1例复发相比，多药片组无复发记录。与常规治疗组(6.8 mm Hg)相比，多药片组收缩压(SBP)显著降低(12.1 mm Hg) (p = 0.002)。在低密度脂蛋白胆固醇≤70 mg/dL的目标方面，没有发现显著差异(41%对44%)。两组的不良事件较轻，发生率相似(9比2%，ns)。两组的依从性同样良好(93% vs. 88%， ns)。Polypill组的依从性与之前的rct荟萃分析报告相似(93比84%，ns)。结论:在我们的经验中，心血管多片剂取得了更高的收缩压水平降低，并且耐受性良好。依从性与之前文献中发现的相似，考虑到我们研究的现实环境，这是值得注意的。
Use of the Cardiovascular Polypill in Secondary Prevention of Cerebrovascular Disease: A Real-Life Tertiary Hospital Cohort Study of 104 Patients.
Background: The use of the cardiovascular polypill, a fixed-dose combination treatment, is conceived to improve adherence. However, randomized controlled trials (RCTs) may overestimate it. Studies focusing on cerebrovascular disease and real-life efficacy compared with conventional treatment are lacking.
Methods: This is a retrospective, hospital-based cohort study of acute ischaemic stroke patients who were prescribed a polypill (aspirin 100 mg, atorvastatin 20/40 mg, ramipril 2.5/5/10 mg) versus conventional treatment (aspirin 100 mg and other blood pressure/lipid-lowering agents) in secondary prevention (2017-2018). Clinical records were reviewed 90 days after discharge for stroke recurrence, vascular risk factor control, and safety. Adherence was assessed using the adapted Morisky-Green scale.
Results: A total of 104 patients were included (61% male; mean age 69.7 ± 13.9 years); 54 were treated with the polypill and 50 with conventional treatment. No baseline differences in clinical or demographic variables were detected. No recurrences were registered in the polypill group, compared to 1 recurrence in the conventional treatment group. A significant reduction of systolic blood pressure (SBP) was achieved in the polypill group (12.1 mm Hg) compared to the conventional treatment group (6.8 mm Hg) (p = 0.002). No significant differences were detected regarding the goal of LDL cholesterol ≤70 mg/dL (41 vs. 44%). The adverse events were mild and their frequency was similar in the two groups (9 vs. 2%, ns). Adherence was similarly good in the two groups (93 vs. 88%, ns). Polypill group adherence was similar to that reported in a previous meta-analysis of RCTs (93 vs. 84%, ns).
Conclusion: In our experience, the cardiovascular polypill achieved a higher reduction in SBP levels and was well tolerated. Adherence was similar to that found in the previous literature, which is remarkable given the real-life setting of our study.
期刊介绍：
This open access and online-only journal publishes original articles covering the entire spectrum of stroke and cerebrovascular research, drawing from a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. Offering an international forum, it meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues. The journal publishes original contributions, reviews of selected topics as well as clinical investigative studies. All aspects related to clinical advances are considered, while purely experimental work appears only if directly relevant to clinical issues. Cerebrovascular Diseases Extra provides additional contents based on reviewed and accepted submissions to the main journal Cerebrovascular Diseases.
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