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Terapias combinadas de dosis fija con y sin aspirina para la prevención primaria de enfermedades cardiovasculares: un

Philip Joseph1, Gholamreza Roshandel2, Peggy Gao1

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Los tratamientos combinados de dosis fijas reducen significativamente los eventos cardiovasculares en la prevención primaria. Los beneficios son consistentes a través de varios factores de riesgo, con la inclusión de aspirina mostrando una mayor eficacia.

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Área de la Ciencia:

  • Cardiología
  • La medicina preventiva
  • Farmacología

Sus antecedentes:

  • Los tratamientos combinados de dosis fijas (polipíldoras) son prometedores para reducir los resultados de las enfermedades cardiovasculares (ECV) en la prevención primaria.
  • Queda incertidumbre en cuanto a la composición óptima, en particular el papel de la aspirina, y los efectos en subgrupos específicos.

Objetivo del estudio:

  • Realizar un metanálisis de los datos de los participantes de grandes ensayos controlados aleatorios (ECA) que evalúen las estrategias de combinación de dosis fijas para la prevención primaria de ECV.
  • Evaluar la eficacia de estas estrategias, incluido el impacto de la aspirina y los efectos en varios subgrupos de pacientes.

Principales métodos:

  • Metaanálisis de datos de participantes individuales de ECA de gran tamaño (≥ 1000 participantes, seguimiento de ≥ 2 años).
  • Se incluyeron ensayos de combinaciones de dosis fijas (≥2 antihipertensivos + estatina ± aspirina) frente al control.
  • Resultado primario: composición de muerte cardiovascular, infarto de miocardio, accidente cerebrovascular o revascularización. Resultados analizados por inclusión de aspirina y subgrupos.

Principales resultados:

  • Tres ECA (18.162 participantes) mostraron una reducción significativa en el resultado compuesto primario (HR 0,62, p< 0,0001) con el tratamiento combinado de dosis fijas.
  • Se observaron reducciones significativas en el infarto de miocardio, la revascularización, el ictus y la muerte cardiovascular.
  • Los beneficios fueron consistentes en todos los subgrupos y factores de riesgo; las estrategias que incluían la aspirina mostraron una mayor reducción del riesgo. El mareo fue más común, pero los eventos de hemorragia mayor fueron raros y similares entre los grupos.

Conclusiones:

  • Las estrategias de tratamiento combinado de dosis fijas reducen significativamente los eventos cardiovasculares importantes y las muertes en la prevención primaria.
  • Estos beneficios son sólidos y consistentes en diversas poblaciones de pacientes y perfiles de factores de riesgo.
  • La inclusión de aspirina en combinaciones de dosis fijas puede mejorar la reducción del riesgo cardiovascular.