The CNIC-polypill (acetylsalicylic acid, atorvastatin, and ramipril), an effective and cost-saving secondary prevention strategy compared with other therapeutic options in patients with ischaemic heart disease

Regina Dalmau; Alberto Cordero; Luís Masana; Emilio Ruiz; Antoni Sicras-Mainar; José R González-Juanatey

doi:10.1093/ehjopen/oeae027

The CNIC-polypill (acetylsalicylic acid, atorvastatin, and ramipril), an effective and cost-saving secondary prevention strategy compared with other therapeutic options in patients with ischaemic heart disease

Eur Heart J Open. 2024 Apr 2;4(2):oeae027. doi: 10.1093/ehjopen/oeae027. eCollection 2024 Mar.

Authors

Regina Dalmau^{1

2}, Alberto Cordero^{3

4}, Luís Masana^{5

6

7}, Emilio Ruiz⁸, Antoni Sicras-Mainar⁹, José R González-Juanatey^{3

10

11}

Affiliations

¹ Department of Cardiology, University Hospital La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
² IdiPAZ (Instituto de Investigación Hospital Universitario la Paz), Pedro Rico 6, 28029 Madrid, Spain.
³ CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain.
⁴ Department of Cardiology, Hospital Universitario de San Juan, N-332 s/n, 03550 Sant Joan d'Alacant, Alicante, Spain.
⁵ Vascular Medicine and Metabolism Unit, Universitat Rovira i Virgili, Hospital Universitario Sant Joan, Vascular Medicine and Metabolism Unit, Avda Josep Laporte 2, 43204 Reus, Spain.
⁶ IISPV (Institut d'Investigació Sanitària Pere Virgili), Avda Josep Laporte 2, 43204 Reus, Spain.
⁷ CIBERDEM (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain.
⁸ Corporate Medical Affairs, Ferrer International, Avenida Diagonal 549, 08029 Barcelona, Spain.
⁹ Departament of Health Economics and Outcomes Research, Atrys Health, Provença 392, 08025 Barcelona, Spain.
¹⁰ Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Rúa da Choupana s/n, 15706 Santiago de Compostela, Spain.
¹¹ Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Rúa da Choupana s/n, 15706 Santiago de Compostela, Spain.

Abstract

Aims: The retrospective NEPTUNO study evaluated the effectiveness of the Centro Nacional de Investigaciones Cardiovasculares (CNIC)-polypill (including acetylsalicylic acid, ramipril, and atorvastatin) vs. other therapeutic approaches in secondary prevention for cardiovascular (CV) disease. In this substudy, the focus was on the subgroup of patients with ischaemic heart disease (IHD).

Methods and results: Patients on four strategies: CNIC-polypill, its monocomponents as loose medications, equipotent medications, and other therapies. The primary endpoint was the incidence of recurrent major adverse CV events (MACEs) after 2 years. After matching, 1080 patients were included in each cohort. The CNIC-polypill cohort had a significantly lower incidence of recurrent MACE compared with monocomponents, equipotent drugs, and other therapies cohorts (16.1 vs. 24, 24.4, and 24.3%, respectively; P < 0.001). The hazard ratios (HRs) for recurrent MACE were higher in monocomponents (HR = 1.12; P = 0.042), equipotent drugs (HR = 1.14; P = 0.031), and other therapies cohorts (HR = 1.17; P = 0.016) compared with the CNIC-polypill, with a number needed to treat of 12 patients to prevent a MACE. The CNIC-polypill demonstrated a greater reduction in LDL cholesterol (LDL-c; -56.1 vs. -43.6, -33.3, and -33.2% in the monocomponents, equipotent drugs, and other therapies, respectively; P < 0.001) and systolic blood pressure (-13.7 vs. -11.5, -10.6, and -9.1% in the CNIC-polypill, monocomponents, equipotent drugs, and other therapies, respectively; P < 0.001) compared with other cohorts. The CNIC-polypill intervention was less costly and more effective than any other therapeutic option, with €2317-€2407 cost savings per event prevented.

Conclusion: In IHD, the CNIC-polypill exemplifies a guideline-recommended secondary prevention treatment linked to better outcomes and cost saving compared with other therapeutic options.

Keywords: CNIC-polypill; Cardiovascular events; Healthcare costs; Ischaemic heart disease; MACE; Secondary prevention.