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

Abstract

Aims The retrospective NEPTUNO study evaluated the effectiveness of the 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 (MACE) after two years. After matching, 1,080 patients were included in each cohort. The CNIC-polypill cohort had a significantly lower incidence of recurrent MACE compared to Monocomponents, Equipotent drugs, and Other therapies cohorts (16.1% vs 24%, 24.4%, and 24.3%, respectively; P<0.001). The hazard ratios (HR) 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 to the CNIC-polypill, with a number needed to treat of 12 patients to prevent a MACE. The CNIC-polypill demonstrated a greater reduction in low-density lipoprotein cholesterol (-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 to other cohorts. The CNIC-polypill intervention was less costly and more effective than any other therapeutic option, with €2,317–€2,407 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 to other therapeutic options.