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Dalmau R, Cordero A, Masana L, Ruiz E, Sicras-Mainar A, González-Juanatey JR. The CNIC-polypill (acetylsalicylic acid, atorvastatin, and ramipril), an effective and cost-saving secondary prevention strategy compared with other therapeutic options in patients with ischaemic heart disease. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae027. [PMID: 38686352 PMCID: PMC11056486 DOI: 10.1093/ehjopen/oeae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 05/02/2024]
Abstract
Aims The retrospective NEPTUNO study evaluated the effectiveness of the Centro Nacional de Investigaciones Cardiovasculares (CNIC)-polypill (including acetylsalicylic acid, ramipril, and atorvastatin) vs. other therapeutic approaches in secondary prevention for cardiovascular (CV) disease. In this substudy, the focus was on the subgroup of patients with ischaemic heart disease (IHD). Methods and results Patients on four strategies: CNIC-polypill, its monocomponents as loose medications, equipotent medications, and other therapies. The primary endpoint was the incidence of recurrent major adverse CV events (MACEs) after 2 years. After matching, 1080 patients were included in each cohort. The CNIC-polypill cohort had a significantly lower incidence of recurrent MACE compared with monocomponents, equipotent drugs, and other therapies cohorts (16.1 vs. 24, 24.4, and 24.3%, respectively; P < 0.001). The hazard ratios (HRs) for recurrent MACE were higher in monocomponents (HR = 1.12; P = 0.042), equipotent drugs (HR = 1.14; P = 0.031), and other therapies cohorts (HR = 1.17; P = 0.016) compared with the CNIC-polypill, with a number needed to treat of 12 patients to prevent a MACE. The CNIC-polypill demonstrated a greater reduction in LDL cholesterol (LDL-c; -56.1 vs. -43.6, -33.3, and -33.2% in the monocomponents, equipotent drugs, and other therapies, respectively; P < 0.001) and systolic blood pressure (-13.7 vs. -11.5, -10.6, and -9.1% in the CNIC-polypill, monocomponents, equipotent drugs, and other therapies, respectively; P < 0.001) compared with other cohorts. The CNIC-polypill intervention was less costly and more effective than any other therapeutic option, with €2317-€2407 cost savings per event prevented. Conclusion In IHD, the CNIC-polypill exemplifies a guideline-recommended secondary prevention treatment linked to better outcomes and cost saving compared with other therapeutic options.
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Affiliation(s)
- Regina Dalmau
- Department of Cardiology, University Hospital La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
- IdiPAZ (Instituto de Investigación Hospital Universitario la Paz), Pedro Rico 6, 28029 Madrid, Spain
| | - Alberto Cordero
- CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
- Department of Cardiology, Hospital Universitario de San Juan, N-332 s/n, 03550 Sant Joan d’Alacant, Alicante, Spain
| | - Luís Masana
- Vascular Medicine and Metabolism Unit, Universitat Rovira i Virgili, Hospital Universitario Sant Joan, Vascular Medicine and Metabolism Unit, Avda Josep Laporte 2, 43204 Reus, Spain
- IISPV (Institut d’Investigació Sanitària Pere Virgili), Avda Josep Laporte 2, 43204 Reus, Spain
- CIBERDEM (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Emilio Ruiz
- Corporate Medical Affairs, Ferrer International, Avenida Diagonal 549, 08029 Barcelona, Spain
| | - Antoni Sicras-Mainar
- Departament of Health Economics and Outcomes Research, Atrys Health, Provença 392, 08025 Barcelona, Spain
| | - José R González-Juanatey
- CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Rúa da Choupana s/n, 15706 Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Rúa da Choupana s/n, 15706 Santiago de Compostela, Spain
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Wang X, Wen D, Fang M, You C, Ma L. Novel Low-Density Lipoprotein Cholesterol Reduction Therapies for the Secondary Prevention of Cardiovascular Disease. Rev Cardiovasc Med 2023; 24:286. [PMID: 39077568 PMCID: PMC11273145 DOI: 10.31083/j.rcm2410286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 07/31/2024] Open
Abstract
Background To date, optimal agents for low-density lipoprotein cholesterol (LDL-C) reduction in patients with established atherosclerotic cardiovascular disease are still being explored. Thus, we evaluated the efficiency of novel LDL-C-lowering therapies in the secondary prevention of cardiovascular events. Methods We included randomized clinical trials (RCTs) that explored the effects of different LDL-C lowering agents including alirocumab, evolocumab, and bempedoic acid in adult patients with cardiovascular disease. Several databases were searched from inception through 2022. The safety endpoint includes new-onset diabetes, serious adverse events, and neurocognitive disorders with at least 1 year of follow-up. The efficacy outcomes included composite adverse cardiovascular outcomes, all-cause death, and cardiovascular death. Results Seven RCTs comprising 53,106 patients were included in this research. Bempedoic acid ranked first in reducing the risk of new-onset diabetes (risk ratio [RR] 0.72, 95% credible interval [CrI] 0.52-0.99) and risk of the composite cardiovascular outcome (RR 0.75, 95% CrI 0.57-0.99). Meta-regression analysis demonstrated that elevated risk of new-onset diabetes was positively correlated with a significant reduction in LDL-C levels (p = 0.03). All treatment agents were associated with a decreased risk of a composite adverse cardiovascular outcome. Conclusions The present analysis showed that bempedoic acid ranked first in reducing the risk of a composite cardiovascular outcome. In addition, it ranked first in reducing the risk of new-onset diabetes compared with placebo and evolocumab. Our analysis also suggests that the increased risk of new-onset diabetes might be associated with a reduction in LDL-C levels. Besides, the present analysis found that alirocumab ranked first in decreasing all-cause mortality and cardiovascular mortality.
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Affiliation(s)
- Xing Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China
| | - Dingke Wen
- Department of Neurosurgery, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China
| | - Mei Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China
- West China Medicine School, Sichuan University, 610041 Chengdu, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China
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Reverté-Villarroya S, Suñer-Soler R, Sauras-Colón E, Zaragoza-Brunet J, Fernández-Sáez J, Lopez-Espuela F. [Ischemic stroke and vascular risk factors in young and older adults. Community-based retrospective study (2011-2020)]. Aten Primaria 2023; 55:102623. [PMID: 37086593 PMCID: PMC10148073 DOI: 10.1016/j.aprim.2023.102623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 04/24/2023] Open
Abstract
OBJECTIVE To analyze the presence of vascular risk factors (VRF) among young adult and older adult patients with ischemic stroke, with and without follow-up in primary care after hospital discharge. DESIGN Observational, retrospective, multicenter study. SETTING Primary care health centers and Hospital Verge de la Cinta, Tortosa, Spain. PARTICIPANTS Patients with ischemic stroke of two age groups (≤55 and ≥65years) distributed in two groups (GroupA: without follow-up in primary care; and GroupB: with follow-up in primary care), between 2011-2020. MAIN MEASUREMENTS Sociodemographic, clinical, and VRF data coded according to the International Classification of Diseases (ICD-10). Descriptive, and inferential statistics. RESULTS Data from 2054 participants were analyzed. In the young adult group, 94.9% of the participants in groupA had between 1-2VRFs, compared to 60% in groupB. In the older adult group, 84.4% of groupA had between 1-2VRFs, compared to 43,9% of groupB. The most frequent VRFs among younger and older adult patients with ischemic stroke were hypertension and dyslipidemia in both follow-up groups. There were no records of obesity, smoking, or alcohol consumption in groupA. There was a significant association between being followed up in primary care after stroke and being a young adult and presenting between 3-4 VRFs (P<0.001). CONCLUSIONS The results reinforce the need for continuity of care and follow-up in people with acute stroke in primary care and the need to improve the quality of registries.
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Affiliation(s)
- Silvia Reverté-Villarroya
- Departamento de Enfermería, Campus Terres de l'Ebre, Universitat Rovira i Virgili, Tortosa, Tarragona, España; Grupo de Investigación Avanzada en Enfermería, Universitat Rovira i Virgili, Tarragona, España
| | - Rosa Suñer-Soler
- Grupo de Investigación Salud y Atención Sanitaria, Facultad de Enfermería, Universidad de Girona, Girona, España.
| | - Esther Sauras-Colón
- Hospital de Tortosa Verge de la Cinta, Unidad de Estudios Clínicos, Institut d'Investigació Sanitària Pere i Virgili, Tortosa, Tarragona, España
| | - Josep Zaragoza-Brunet
- Hospital de Tortosa Verge de la Cinta, Unidad de Estudios Clínicos, Institut d'Investigació Sanitària Pere i Virgili, Tortosa, Tarragona, España
| | - José Fernández-Sáez
- Departamento de Enfermería, Campus Terres de l'Ebre, Universitat Rovira i Virgili, Tortosa, Tarragona, España; Unitat de Support a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Tarragona, España
| | - Fidel Lopez-Espuela
- Grupo de Investigación en Enfermedades Metabólicas Óseas, Departamento de Enfermería, Universidad de Extremadura, Cáceres, España; Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, España
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Aortic calcification index predicts mortality and cardiovascular events in operatively treated patients with peripheral artery disease A prospective PUREASO cohort follow-up study. J Vasc Surg 2022; 76:1657-1666.e2. [PMID: 35810957 DOI: 10.1016/j.jvs.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/24/2022] [Accepted: 07/01/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Present study evaluates the association of aortic calcification to mortality and major adverse cardiovascular and leg events (MACE and MALE) in patients with peripheral artery disease (PAD). The risk for mortality and MACE and MALE events is considered in clinical decision making. METHODS This cohort found in 2012 - 2013 consists of 226 symptomatic PAD patients referred to Turku University Hospital for invasive treatment. Follow-up data about mortality and survival without MACEs and MALEs was collected up to 5 years from inclusion date and aortic calcification index (ACI) was measured from patients with available imaging studies (164 of 226). ACIs association with events and mortality was evaluated in Cox regression, Kaplan-Meier and Classification and regression tree analysis. RESULTS All-cause mortality at 1, 3 and 5 years was 13.7%, (31), 26.1% (59) and 46.9% (106), respectively. In multivariable Cox regression analysis ACI and ACI>43 were independent risk factors for all-cause mortality (HR 1.13 per 10 units 95%CI, 1.00-1.22 and HR 1.83, 95%CI, 1.01-3.32, respectively) and for MACE (HR 1.10 per 10 units, 95%CI, 1.00-1.22 and HR 3.14, 95%CI, 1.67-5.91, respectively), but not for MALES. Classification and regression tree analysis showed that ACI 43 best divides cohort in relation to mortality. Kaplan-Meier analyses showed that ACI>43 is associated with greater mortality and occurrence of MACEs compared to those who have ACI≤43 (log-rank p-value 0.005 and 0.0012, respectively). CONCLUSION Risk for mortality and MACEs is associated with high ACI. ACI can expose PAD patients' risk for further cardiovascular events and mortality.
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