Abstract
The main objective of cardiovascular disease (CVD) prevention is to reduce morbidity and mortality. Despite recommendations on evidence-based pharmacological treatment and lifestyle changes, the control of CV risk factors such as hypertension or dyslipidaemia is not optimal. The use of a CV polypill, including guideline-recommended drugs, as a baseline therapy, may contribute to improving risk factors control either by improving the treatment adherence or by the synergistic effect of its components. The CNIC-Polypill is the first CV polypill approved in Europe as an effective strategy for secondary prevention, which contains acetylsalicylic acid, atorvastatin (in two optional doses), and ramipril (in three optional doses) in a single pill. The present practical clinical document aims to provide a guide for patient management after an acute coronary syndrome (ACS) or with chronic CVD (CCVD) with a strategy based on the CNIC-Polypill, also considering the need to add other therapies for a personalized treatment. The most suitable clinical scenarios for the CNIC-Polypill use are discussed: (a) in patients after an ACS at discharge, (b) in patients with CCVD (chronic coronary syndrome, stroke, or peripheral artery disease) with uncontrolled low-density lipoprotein cholesterol (LDL-c) and/or blood pressure levels and (c) in patients with CCVD with well-controlled risk factors to simplify treatment and reduce polypharmacy in the context of CCVD prevention.
Highlights
Cardiovascular disease (CVD) is a global condition that represents the main cause or mortality and morbidity worldwide [1]
Additional drugs might be added for a better risk factor control such as ezetimibe and/or proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), diuretics, beta blockers (BB) or calcium channel blockers (CCBs), and a P2Y12 inhibitor
Here, we provide practical decision algorithms to facilitate the use of the CNIC-Polypill strategy in patients with acute coronary syndrome (ACS) and patients with an established CVD, including chronic coronary syndrome (CCS), stroke or peripheral artery disease (PAD)
Summary
Cardiovascular disease (CVD) is a global condition that represents the main cause or mortality and morbidity worldwide [1]. Patients on ASA/Statin but Not on BP-Lowering Treatment or Low Doses of ACEI or ARB The switch to the CNIC-Polypill is an option that will only require to use of the formulation with the adequate dose of ramipril and atorvastatin (or additional lipid-lowering drugs) based on the baseline LDL-c levels (i.e., close to target or 100 mg/dl). Patients on ASA/Statin/ACEI or ARB Plus a CCB and a Diuretic For these subjects, the CNIC-Polypill, chosen based on the required ramipril and atorvastatin doses, must be combined with an FDC of CCB plus a diuretic, and the clinician needs to consider intensifying treatment with an additional BP-lowering drug excluding another renin–angiotensin–aldosterone system (RAAS) blocker as it is contraindicated in the summary of product characteristics (SmPC) of ramipril. Please note that the use of an FDC with three antihypertensive components may not be common in some European countries, meaning that the benefit of the CNIC-Polypill will lower the pill burden from five (if multiple independent pills) or four (if using a two-drug FDC of ACEI/ARB plus a CCB or a diuretic) to two pills
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