Effectiveness of the CNIC polypill in secondary cardiovascular prevention in the subgroup of patients of the NEPTUNO study using atorvastatin doses of 20 mg

José R. González-Juanatey, Departamento de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela (La Coruña); Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV); Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela (La Coruña); España
Alberto Cordero, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV); Departamento de Cardiología, Hospital Universitario de San Juan, Alicante; España
Luis Masana, Unidad de Medicina Vascular y Metabolismo, Hospital Universitario Sant Joan de Reus, Universitat Rovira i Virgili, Reus (Tarragona); Institut d’Investigació Sanitària Pere Virgili, Reus (Tarragona); Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM); España
Regina Dalmau, Departamento de Cardiología, Hospital Universitario la Paz, Madrid; Instituto de Investigación Hospital Universitario la Paz, Madrid; España

Objective: To analyse the incidence and risk of recurrent major adverse cardiovascular events (MACE), level of risk factor control, treatment persistence and cost of the CNIC polypill version containing acetylsalicylic acid (ASA) 100 mg, atorvastatin 20 mg (A20), and ramipril 2.5, 5.0 or 10 mg in secondary cardiovascular prevention patients. Method: Subanalysis of the observational, retrospective, multicentre, NEPTUNO study in patients treated for two years with the CNIC polypill A20, the same monocomponents as single drugs, equipotent drugs, and other therapies. Results: 922 patients were included in each group. The risk of recurrent MACE was lower among CNIC A20 polypill users than all others (21%, 23% and 26% increased risk among the monocomponents, equipotent or other therapy cohorts, respectively; p < 0.05). The magnitude of the mean change in low-density lipoprotein cholesterol and blood pressure, as well as the increase in the proportion of patients achieving target goals, was also greater among patients treated with the CNIC A20 polypill than in any of the other cohorts (all p < 0.001). Treatment persistence was significantly higher in patients treated with the CNIC A20 polypill (p < 0.001) and was a less costly strategy than any other therapeutic option. Conclusions: In patients in secondary cardiovascular prevention, the CNIC A20 polypill (ASA 100 mg, atorvastatin 20 mg, and ramipril 2.5, 5.0 or 10 mg) constitutes a valid therapeutic option with similar benefits and outcomes to the version of the polypill with atorvastatin 40 mg.

Keywords: Secondary prevention. Cardiovascular events. Major adverse cardiovascular events. Health resources. Health care costs. Cardiovascular risk factor. CNIC polypill.