Science

Cardiovascular disease: new 3-in-1 drug significantly reduces risk of death

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For the treatment of cardiovascular disease, most of the treatments available often target only one or a few targets, depending on the symptoms present. However, cardiac pathologies cover a very large set of conditions, all the symptoms of which are interconnected. To provide effective relief to patients, doctors are often forced to recommend multiple treatments at the same time. A group of scientists tried to combine several existing drugs (three) that treat different heart symptoms into one. A large clinical study has shown that the 3-in-1 preparation is significantly more effective in preventing cardiac events (heart attack, stroke, cardiac arrest, etc.) than tablets administered one at a time.

Cardiovascular diseases that affect the heart and the entire circulatory system include atherosclerosis, arrhythmia, hypertension, heart failure, and others. Although scientists have made great strides in therapeutic strategies, some patients still require a combination of several types of treatment at the same time, and this is the whole life, to relieve symptoms.

In particular, the treatment should be combined, because a patient with heart disease often requires intervention on all fronts. Take, for example, the case of an obese patient suffering from arterial hypertension. His hypertension in this case would be due to atherosclerosis caused by high cholesterol. Thus, his blood vessels cannot provide normal blood flow, which greatly increases the mechanical stress in the arteries. And as the heart struggles to naturally adapt to try and normalize blood flow, the patient may also experience tachycardia (excessively high heart rate) or angina (feeling pain in the heart due to reduced blood flow).

The patient will then need an anticoagulant to keep their blood thin enough to avoid the risk of clot blockage and ensure normal blood flow. In parallel, it is also necessary to treat his atherosclerosis by lowering his cholesterol levels with a cholesterol-lowering drug. It is also necessary to relieve tension at the level of her arteries with a molecule that regulates vasoconstriction, in particular by inhibiting the formation of angiotensin II (vasoconstrictor hormone). And this is three different drugs for one patient.

In other cases, and especially the most serious ones, cardiologists may also add beta-blockers in addition to these three treatments. These therapies markedly inhibit adrenergic neurotransmitters and regulate heart rate. However, the body tends to adapt to such drugs by increasing the number of adrenergic hormone receptor cells in the heart. This phenomenon is especially observed in hypertrophic cardiomyopathies, when the volume of the patient’s heart sometimes increases dramatically. These inconveniences then force physicians to re-adapt the dosage and combination of treatments for patients with cardiovascular disease throughout their lives.

To develop more effective therapeutic strategies, scientists have been thinking about combining different treatments into one for several years. A new study, detailed in The New England Journal Of Medicine, proposed testing this strategy on a large scale, using a combination of blood thinners, cholesterol-lowering drugs, and angiotensin II-converting enzyme inhibitors.

“The results of the SECURE study show for the first time that a polypill containing aspirin, ramipril, and atorvastatin provides a clinically meaningful reduction in the rate of recurrent cardiovascular events in people who have recovered from a previous heart attack, due to better adherence to this regimen. approach rather than taking the drugs individually in the usual way,” explains Valentin Fuster, principal investigator of the new study.

Large scale clinical trial

As part of their clinical trial, the research team recruited about 2,500 participants from seven different countries. The new drug, called Trinomia, combines aspirin, ramipril and atorvastatin, molecules often prescribed to patients with cardiovascular disease. The participants were divided into two groups: one took the polypill and the other took the three drugs separately. Then all this was observed for an average of three years.

At the end of the study, the results showed that the polypill group was 33% less likely to die from a serious cardiovascular event, such as a stroke or heart attack. Compared to the conventional treatment group, the Trinomia group also had a 24% lower risk of these serious cardiovascular events.

These results prove that patients are more likely to stick to a single-pill treatment rather than taking three different drugs a day, the researchers said. However, it should be noted that the side effects remained the same in both groups of participants.

“Our goal was to make an impact early on, and most of the patients in the study began taking the simple polypill within the first week after their heart attack,” says Fuster. “By simplifying treatment and increasing adherence, this approach could reduce the risk of recurrent CVD and death worldwide,” he concludes.

New England Journal of Medicine.

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