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.
Cerebrovasc Dis Extra 2020;10:166–173

中文翻译：

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心血管息肉在二级预防脑血管疾病中的应用：现实生活中的三级医院队列研究，共104例患者

背景：心血管多药是一种固定剂量的联合治疗，旨在改善依从性。但是，随机对照试验（RCT）可能会高估它。与常规治疗相比，缺乏针对脑血管疾病和实际疗效的研究。方法：这是一项针对急性缺血性中风患者的回顾性，基于医院的队列研究，这些患者接受了多药治疗（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和其他血压） /降脂药）在二级预防中（2017-2018）。出院后90天回顾临床记录，以中风复发，控制血管危险因素和安全性。使用改良的Morisky-Green量表评估粘附性。结果：共纳入104例患者（男性61％；平均年龄69.7±13.9岁）；息肉治疗54例，常规治疗50例。未检测到临床或人口统计学变量的基线差异。在多药丸组中未发现复发，而常规治疗组中只有1次复发。与传统治疗组（6.8 mm Hg）相比，多药丸组（12.1 mm Hg）的收缩压（SBP）显着降低（p= 0.002）。对于LDL胆固醇≤70 mg / dL的目标，未发现明显差异（41％对44％）。两组的不良事件轻微，发生频率相似（9％vs. 2％，ns）。两组的依从性也相似（93比88％，ns）。Polypill组的依从性与先前对RCT的荟萃分析中报道的相似（93比84％，ns）。结论：根据我们的经验，心血管息肉药可降低SBP水平并具有良好的耐受性。坚持与以前的文献中发现的相似，考虑到我们研究的真实情况，这一点非常显着。
Cerebrovasc Dis Extra 2020; 10：166–173