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多种药物的初级和二级预防心血管疾病的有效性 (PolyIran):实用性,集群随机试验
Gholamreza Roshandel1, Masoud Khoshnia1, Hossein Poustchi2
1Digestive Disease Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
Lancet (London, England)
|August 27, 2019
概括
在PolyIran研究中,多种药物策略显著减少了参与者的重大心血管事件的34%. 特别是在低收入和中等收入国家,
科学领域:
- 预防心血管疾病
- 公共卫生干预措施
- 药物治疗方法
背景情况:
- 心血管疾病 (CVD) 在全球造成重大健康负担,特别是在低收入和中等收入国家 (LMICs).
- 固定剂量组合疗法或多药剂策略提供了一种有前途的方法来简化治疗方案并提高对心脏病预防的坚持.
- 在PolyIran研究中,研究了一种由四种成分组成的多种药物的疗效和安全性,用于一次性和二次性心血管疾病预防.
研究的目的:
- 评估多药剂策略在减少重大心血管事件方面的有效性.
- 评估与多种药物治疗方案相关的安全性和坚持率.
- 确定多种药物的潜力,作为在LMIC中控制心脏病的公共卫生工具.
主要方法:
- 一项实用性,随机集群试验,涉及6838名年龄在40至75岁之间的伊朗参与者.
- 参与者被随机分配到接受最低限度的护理 (非药物干预) 或最低限度的护理加每日多药丸 (阿司匹林,阿托瓦斯塔丁,化,埃纳拉普利尔/ 瓦尔萨坦).
- 主要结局是60个月的随访期内发生的重大心血管事件,并进行治疗意向分析.
主要成果:
- 与最少治疗组相比,多药丸组的重大心血管事件减少了34% (调整后HR为0.66;95% CI为0.5 - 0.80).
- 观察到高的多药药治疗中位数 (80. 5%).
- 两组之间不良事件的发生率相似,包括内出血和胃肠道上部出血.
结论:
- 在预防重大心血管事件方面, 多种药物策略是有效的.
- 这种药物具有很高的药物坚持性和良好的安全性,
- 多种药丸方法是心血管疾病管理的可行和有效策略,特别是在资源有限的环境中.
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