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首页> 外文期刊>The American heart journal >The combined use of aspirin, a statin, and blood pressure-lowering agents (polypill components) and the risk of vascular morbidity and mortality in patients with coronary artery disease
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The combined use of aspirin, a statin, and blood pressure-lowering agents (polypill components) and the risk of vascular morbidity and mortality in patients with coronary artery disease

机译：阿司匹林，他汀类药物和降血压药（多药丸成分）的联合使用以及冠心病患者的血管发病和死亡风险

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Background and Aims Patients with established coronary artery disease (CAD) are likely to receive a combination of aspirin, a statin, and blood pressure (BP)-lowering agents. Combining these pharmacologic agents into a cardiovascular combination pill, such as a polypill, could be considered to reduce prescription gaps and nonadherence in high-risk patients. We aimed to evaluate the effect of the concomitant use of aspirin, a statin, and BP-lowering agent(s) in patients with CAD on vascular morbidity and mortality in current clinical practice in an observational study to provide insights in the combination pill concept related to feasibility and applicability. Methods In total, 2,706 patients with CAD enrolled in the Second Manifestations of ARTerial disease study were followed for the occurrence of a subsequent vascular event (ie, myocardial infarction, ischemic cerebrovascular accident, vascular death) and all-cause mortality. The relationship between combination therapy and cardiovascular events and all-cause mortality was assessed using Cox proportional hazards regression models to calculate hazards ratios (HRs) with a 95% CI. Both covariate and propensity score adjusting methods were used to reduce confounding by indication. Results A combination of aspirin, a statin, and ≥1 BP-lowering agent(s) was used by 67% of the patients. During a median of 5.0 years (interquartile range 2.4-10.2 years), 347 vascular events occurred and 162 patients died. Combination therapy with aspirin, statin, and ≥1 BP-lowering agent was associated with a lower risk of myocardial infarction (HR 0.68, 95% CI 0.49-0.96), ischemic cerebrovascular accident (HR 0.37, 95% CI 0.16-0.84), composite vascular end point (HR 0.66, 95% CI 0.49-0.88), vascular mortality (HR 0.53, 95% CI 0.33-0.85), and all-cause mortality (HR 0.69, 95% CI 0.49-0.96) compared with the absence of combination therapy, after adjusting for confounding covariates in a propensity score. The use of 1 or only 2 components of combination therapy was associated with a higher risk for cardiovascular events compared with the combined use of aspirin, a statin, and ≥1 BP-lowering agent(s). Conclusion Two-thirds of the patients with CAD use a combination of aspirin, a statin, and ≥1 BP-lowering agent(s), components of a cardiovascular fixed-dose combination pill. Combination therapy with these agents is associated with a lower risk of vascular events and total mortality. Although treatment effect in observational studies should be interpreted with caution, the results of this study support supposed benefits from combination therapy. However, the effect of fixed-dose combination pill on clinical outcome needs to be demonstrated in randomized clinical trials.
机译：背景和目标患有冠状动脉疾病（CAD）的患者可能会接受阿司匹林，他汀类药物和降血压药的组合。可以考虑将这些药物组合到心血管合用药丸（例如多药丸）中，以减少高风险患者的处方空白和不依从性。我们旨在通过一项观察性研究评估目前临床实践中阿司匹林，他汀类药物和降血压药在CAD患者中并用对血管发病率和死亡率的影响，以提供与联合用药概念相关的见解可行性和适用性。方法总共纳入了2706例参与第二次动脉疾病表现研究的CAD患者，以观察其后发生的血管事件（即心肌梗死，缺血性脑血管意外，血管死亡）和全因死亡率。使用Cox比例风险回归模型评估联合治疗与心血管事件和全因死亡率之间的关系，以计算95％CI的风险比（HRs）。协变量和倾向评分调整方法均用于减少适应症的混淆。结果67％的患者使用了阿司匹林，他汀类药物和≥1 BP降低剂。在中位时间5.0年（四分位间距2.4-10.2年）内，发生了347例血管事件，有162例患者死亡。阿司匹林，他汀类药物和降血压药≥1的联合治疗与降低心肌梗死（HR 0.68，95％CI 0.49-0.96），缺血性脑血管意外（HR 0.37，95％CI 0.16-0.84）相关，与不存在时相比，复合血管终点（HR 0.66，95％CI 0.49-0.88），血管死亡率（HR 0.53，95％CI 0.33-0.85）和全因死亡率（HR 0.69，95％CI 0.49-0.96）调整倾向评分中的混杂变量后，进行联合治疗。与阿司匹林，他汀类药物和降压药≥1种联合使用相比，联合治疗中仅使用一种或两种成分与心血管事件的风险更高。结论三分之二的CAD患者使用阿司匹林，他汀类药物和≥1 BP降低剂的组合，这是心血管固定剂量组合药的成分。与这些药物联合治疗可降低血管事件和总死亡率的风险。尽管观察性研究中的治疗效果应谨慎解释，但该研究结果支持联合治疗的益处。但是，固定剂量联合用药对临床结局的影响需要在随机临床试验中证实。

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