A strategy to reduce cardiovascular disease by more than 80%
A strategy to reduce cardiovascular disease by more than 80%
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DOI：
10.1136/bmj.326.7404.1419
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发表时间：
2003-06-28
影响因子：
105.7
通讯作者：
Law, MR
中科院分区：
文献类型：
--
作者：
Wald, NJ;Law, MR
目的确定药物和维生素的组合及其剂量，以便在每日一次服用中达到预防心血管疾病的大效果和最小的不良反应。策略是同时降低四种心血管危险因素（低密度脂蛋白胆固醇、血压、血清同型半胱氨酸和血小板功能），而不考虑预处理水平。我们从已发表的随机试验和队列研究的荟萃分析以及15项低剂量（50-125 mg/天）阿司匹林试验的荟萃分析中量化了所建议配方的疗效和不良反应。结果测量缺血性心脏病（IHD）事件和中风的比例减少；寿命增加；以及不良反应的发生率。符合我们目标的处方是：他汀类药物(例如，阿托伐他汀（日剂量10mg）或辛伐他汀（40mg）；三种降压药（如噻嗪类药物、P受体阻滞剂和血管紧张素转换酶抑制剂），各为标准剂量的一半；叶酸（0.8毫克）；阿司匹林（75毫克）。我们估计联合用药（我们称之为Polypill）可使IHD事件减少88%(95%置信区间为84%至91%)，卒中事件减少80%（71%至87%）。从55岁开始服用此药的人中，有三分之一的人将从中受益，平均增加约1.1年的寿命，而不会出现IHD事件或中风。将随机试验中观察到的各成分的不良反应加起来表明，这种多药片会导致8-15%的人出现症状（取决于确切的配方）。结论55岁及以上人群和有心血管疾病的人群均服用复方多药片可有效预防心梗和脑卒中。它的安全性是可以接受的，如果得到广泛使用，对西方世界的疾病预防将产生比其他单一干预措施更大的影响。
Objectives To determine the combination of drugs and vitamins, and their doses, for use in a single daily pill to achieve a large effect in preventing cardiovascular disease with minimal adverse effects. The strategy was to simultaneously reduce four cardiovascular risk factors (low density lipoprotein cholesterol, blood pressure, serum homocysteine, and platelet function) regardless of pretreatment levels.Design We quantified the efficacy and adverse effects of the proposed formulation from published meta-analyses of randomised trials and cohort studies and a meta-analysis of 15 trials of low dose (50-125 mg/day) aspirin.Outcome measures Proportional reduction in ischaemic heart disease (IHD) events and strokes; life years gained; and prevalence of adverse effects.Results The formulation which met our objectives was: a statin (for example, atorvastatin (daily dose 10 mg) or simvastatin (40 mg); three blood pressure lowering drugs (for example, a thiazide, a P blocker, and an angiotensin converting enzyme inhibitor), each at half standard dose; folic acid (0.8 mg); and aspirin (75 mg). We estimate that the combination (which we call the Polypill) reduces IHD events by 88% (95% confidence interval 84% to 91%) and stroke by 80% (71% to 87%). One third of people taking this pill from age 55 would benefit, gaining on average about I I years of life free from an IHD event or stroke. Summing the adverse effects of the components observed in randomised trials shows that the Polypill would cause symptoms in 8-15% of people (depending on the precise formulation).Conclusion The Polypill strategy could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing cardiovascular disease. It would be acceptably safe and with widespread use would have a greater impact on the prevention of disease in the Western world than an), other single intervention.