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

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  1   2 , Alberto Cordero  3   4 , Luís Masana  5   6   7 , Emilio Ruiz  8 , Antoni Sicras-Mainar  9 , José R González-Juanatey  3   10   11
Affiliations

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 et al. Eur Heart J Open. .

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.

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Conflict of interest statement

Conflict of interest: R.D. reports consulting fees from Ferrer International, Amarin Sanofi, and Amgen; payment or honoraria for lectures from Novo Nordisk, Novartis, Ferrer, Amarin, Sanofi, Daiichi Sankio, and AMGEN; support for attending meetings and/or travel from Ferrer International, Novartis, Sanofi, Amarin, and Daiichi Sankio; has participated on Data Safety Monitoring Board or Advisory Board for Sanofi, and holds leadership or fiduciary roles in the World Heart Federation. A.C. reports honoraria consulting fees from AstraZeneca, Ferrer, Sanofi, AMGEN, Novartis, Lilly, Novo Nordisk, and Amarin; payment or honoraria for lectures from AstraZeneca, Ferrer, Sanofi, AMGEN, Novartis, Lilly, Novo Nordisk, and Amarin; and support for attending meetings and/or travel from Ferrer, Sanofi, AMGEN, Daiichi Sankio, Novartis, Novo Nordisk, and Amarin. L.M. reports honoraria consulting fees and payment or honoraria for lectures from Amgen, Sanofi, Novartis, Ferrer International, Servier, Daiichi Sankyo, Amarin, and Amryt. E.R. is a current worker at Ferrer International. A.S.-M. was working at Atrys Health at the time of the study. J.R.G.-J. reports honoraria for consulting and lectures from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, MSD, Daichi Sankyo, Ferrer International, Novartis, Lilly, Sanofi, and Servier.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Cumulative incidence of major adverse cardiovascular event of individuals evaluated at 2 years (A) and risk of major adverse cardiovascular event (B) among the different treatment cohorts. CI, confidence interval; CNIC-polypill, acetylsalicylic acid 100 mg, atorvastatin 20/40 mg, and ramipril 2.5/5.0/10 mg; HR, hazard ratio.
Figure 2
Figure 2
Evolution of cardiovascular risk factors from baseline for lipid parameters (A–D) and blood pressure (E, F) by treatment cohort. *P < 0.001, with the CNIC-polypill (acetylsalicylic acid 100 mg, atorvastatin 20/40 mg, and ramipril 2.5/5.0/10 mg) as the reference cohort. CV, cardiovascular; DBP, diastolic blood pressure; HDL-c, HDL cholesterol; LDL-c, LDL cholesterol; SBP, systolic blood pressure; SD, standard deviation.
Figure 3
Figure 3
Adjusted average costs* per patient during the follow-up by treatment cohort. *Models corrected for age, sex, and Charlson comorbidity index. **P < 0.01, with the CNIC-polypill (acetylsalicylic acid 100 mg, atorvastatin 20/40 mg, and ramipril 2.5/5.0/10 mg) as the reference cohort. ***P < 0.001, with the CNIC-polypill (acetylsalicylic acid 100 mg, atorvastatin 20/40 mg, and ramipril 2.5/5.0/10 mg) as the reference cohort.
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