美国范德比尔特大学医学中心Thomas J. Wang研究团队近日取得一项新成果。他们发现低剂量药物联合药丸（复方丸）可用于服务不足的人群以预防心血管疾病。 相关论文发表在2019年9月18日出版的《新英格兰医学杂志》上。

研究组进行了一项随机对照试验，招募没有心血管疾病的成年人。将其分配至阿拉巴马州联邦认证社区卫生中心随机接受复方丸或普通治疗。复方丸的成分包括阿托伐他汀10mg、氨氯地平2.5mg、氯沙坦25mg和氢氯噻嗪12.5mg。

该试验共招募了303名成年人，其中96%为黑人，四分之三年收入低于15000美元。平均预测10年心血管风险为12.7%，基线血压为140/83 mmHg，基线低密度脂蛋白胆固醇水平为113 mg/dL。复方丸的每月费用为26美元。12个月时，根据药片数量评估，复发丸组患者的依从性为86%，平均收缩压下降了9 mmHg，显著大于普通治疗组（2 mmHg）；低密度脂蛋白胆固醇水平每分升降低15 mg，显著优于普通治疗组（每分升4 mg）。

总之，在社会经济弱势的少数群体中，复方丸与普通治疗相比，其降压降脂疗效更显著。

据悉，美国社会经济地位较低者和非白人群体患心血管疾病的风险更大。复方丸可能有益于预防心血管疾病。然而，在美国服务不足的社区中使用复方丸的资料很少，且对指南护理的遵守率较低。

附：英文原文

Title: Polypill for Cardiovascular Disease Prevention in an Underserved Population

Author: Daniel Muoz, Prince Uzoije, Cassandra Reynolds, Roslynn Miller, David Walkley, Susan Pappalardo, Phyllis Tousey, Heather Munro, Holly Gonzales, Wenliang Song, Charles White, William J. Blot, Thomas J. Wang

Issue&Volume: Vol 381 No 12

Abstract:

Background

Persons with low socioeconomic status and nonwhite persons in the United States have high rates of cardiovascular disease. The use of combination pills (also called “polypills”) containing low doses of medications with proven benefits for the prevention of cardiovascular disease may be beneficial in such persons. However, few data are available regarding the use of polypill therapy in underserved communities in the United States, in which adherence to guideline-based care is generally low.

Methods

We conducted a randomized, controlled trial involving adults without cardiovascular disease. Participants were assigned to the polypill group or the usual-care group at a federally qualified community health center in Alabama. Components of the polypill were atorvastatin (at a dose of 10 mg), amlodipine (2.5 mg), losartan (25 mg), and hydrochlorothiazide (12.5 mg). The two primary outcomes were the changes from baseline in systolic blood pressure and low-density lipoprotein (LDL) cholesterol level at 12 months.

Results

The trial enrolled 303 adults, of whom 96% were black. Three quarters of the participants had an annual income below $15,000. The mean estimated 10-year cardiovascular risk was 12.7%, the baseline blood pressure was 140/83 mm Hg, and the baseline LDL cholesterol level was 113 mg per deciliter. The monthly cost of the polypill was $26. At 12 months, adherence to the polypill regimen, as assessed on the basis of pill counts, was 86%. The mean systolic blood pressure decreased by 9 mm Hg in the polypill group, as compared with 2 mm Hg in the usual-care group (difference, −7 mm Hg; 95% confidence interval [CI], −12 to −2; P=0.003). The mean LDL cholesterol level decreased by 15 mg per deciliter in the polypill group, as compared with 4 mg per deciliter in the usual-care group (difference, −11 mg per deciliter; 95% CI, −18 to −5; P<0.001).

Conclusions

A polypill-based strategy led to greater reductions in systolic blood pressure and LDL cholesterol level than were observed with usual care in a socioeconomically vulnerable minority population.

DOI: 10.1056/NEJMoa1815359

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1815359