OCC-WCC 2024丨WCC固定剂量联合疗法和复方药片论坛：如何助力2030心血管疾病死亡率降低？FDC带来新选择|依从性|复方药片|心血管疾病|治疗

心血管疾病已成为全球健康的头号敌人，针对心血管疾病防治的研究始终充满机遇和挑战。2024年6月28日，在第十八届东方心脏病学会议（OCC）和世界心脏病学大会（WCC）设立的固定剂量联合疗法和复方药片论坛上，来自全球各国专家们聚焦复方药片在心血管疾病治疗中的应用，共同探讨复方药片在降低心血管疾病死亡率方面的实际效果和未来发展前景。专家们各抒己见，妙语不断。让我们一起回顾WCC固定剂量联合疗法和复方药片论坛的精彩瞬间和名家观点！

Cardiovascular disease has become the number one enemy of global health, and research on the prevention and treatment of cardiovascular disease is always full of opportunities and challenges. On June 28, 2024, at the Fixed-Dose Combination Therapy and Compound Tablets Forum established by the 18th Oriental Cardiology Conference (OCC) and World Congress of Cardiology (WCC), experts from all over the world focused on the application of compound tablets in the treatment of cardiovascular diseases and discussed the actual effects and future development prospects of compound tablets in reducing cardiovascular disease mortality. Experts expressed their opinions and made witty remarks. Let us review the wonderful moments and opinions of famous experts at the WCC Fixed-Dose Combination Therapies and Polypill Forum!

José R. Gonzalez-Juanatey教授：

循证——使用复方药片有助于二级预防降低死亡率

来自西班牙国家心血管研究中心的José R. Gonzalez-Juanatey教授表示，应该将指南建议有效转化到日常实践中，尤其是二级预防患者。José教授通过PURE研究阐述了无法实现优化患者管理目标的原因，包括二级预防全民覆盖率低、医疗工作者将指南建议落地不坚决和患者配合度低。总结以上不同的障碍，核心在于优化二级预防和使用经过验证的心血管药物。José教授强调，目前他汀类药物、血管紧张素转换酶抑制剂（ACE）、抗血小板药物在全球范围内的使用率并不理想。SECURE研究结果显示，心肌梗死后6个月内使用抗血小板药物、ACEI和他汀类药物的复方药片治疗，发生重大心血管不良事件的风险明显低于常规治疗，该研究明确表明复方药片能够让患者获益。NEPTUNO研究是一项针对接受多效固定复方药物（CNIC-Polypill）治疗患者的真实世界临床研究，结果显示，与单独使用相同或等效药物的患者相比，接受CNIC-Polypill治疗的患者发生MACE的风险显著降低，其心血管危险因素控制更好，二级预防治疗能坚持更长时间。目前，降压、降脂、抗血小板等多种复方药片已被多部国外指南推荐。José教授最后总结道，在不同地区、不同环境中运用复方药片，其目的都是改善疾病预后，早期使用复方药片的获益显著高于使用其它常用单药。

Professor José R. Gonzalez-Juanatey from the Spanish National Center for Cardiovascular Research said that the guideline recommendations should be effectively translated into daily practice, especially for secondary prevention patients. Through the PURE study, Professor José explained the reasons why the goal of optimizing patient management could not be achieved, including low universal coverage of secondary prevention, medical workers' lack of determination to implement the guideline recommendations, and low patient compliance. To summarize the above different obstacles. He mentioned that the core lies in optimizing secondary prevention and using proven cardiovascular drugs. Professor José emphasized that the current global use of statins, angiotensin-converting enzyme inhibitors (ACE), and antiplatelet drugs is not ideal. The results of the SECURE study showed that the risk of major adverse cardiovascular events was significantly lower than conventional treatment when antiplatelet drugs, ACEI, and statins were used in combination tablets within 6 months after myocardial infarction. The study clearly showed that combination tablets can benefit patients. The NEPTUNO study is a real-world clinical study of patients treated with a multi-effect fixed combination drug (CNIC-Polypill). The results showed that compared with patients who used the same or equivalent drugs alone, patients treated with CNIC-Polypill had a significantly lower risk of MACE, better control of cardiovascular risk factors, and longer duration of secondary prevention treatment. Currently, a variety of compound pills such as antihypertensive, lipid-lowering, and antiplatelet have been recommended by many foreign guidelines. Professor José concluded that the purpose of using polypill in different regions and environments is to improve the prognosis of the disease, and the benefits of early use of compound pills are significantly higher than those of other commonly used single drugs.

Vilma Irazola教授：

固定剂量联合疗法和复方药片有助于平衡药物治疗的依从性和临床惯性

来自阿根廷布宜诺斯艾利斯大学的Vilma Irazola教授介绍了临床惯性的含义，即当用传统治疗药物无法实现治疗目标时，仍不启用新药物，这种情况非常常见。Vilma教授认为，临床治疗中出现的不良事件不仅仅因为临床惯性，还应该归因于患者的低依从性。临床惯性源于多种因素，如过度依赖单一治疗、医疗工作者存在新疗法不如传统疗法的误解、担心新疗法引发并发症或无法控制并发症，以及来源于不同国家或者不同学会的复杂临床指南。这些因素都会对医疗工作者的判断或选择产生一定影响。而患者的低依从性主要源于服用药物的数量多、对新疗法的恐惧感等。在临床中使用固定剂量联合疗法和复方药片、建立新疗法体系、对医疗工作者进行专业培训等方法可减少临床惯性。另外需要加强患者教育，以提高患者依从性。Vilma教授最后总结道，越来越多的证据表明，固定剂量联合疗法和复方药片能够减少药物种类和剂量，简化治疗方案，同时有助于减少药物间的相互作用，进一步提升患者的依从性和长期治疗效果。

Professor Vilma Irazola from the University of Buenos Aires in Argentina introduced the meaning of clinical inertia, which is that when traditional treatment drugs cannot achieve the treatment goals, new drugs are still not used. This situation is very common. Professor Vilma believes that adverse events in clinical treatment are not only due to clinical inertia, but also due to low patient compliance. Clinical inertia stems from many factors, such as over-reliance on single treatment, misunderstandings among medical workers that new treatments are not as good as traditional treatments, concerns about complications caused by new treatments or inability to control complications, and complex clinical guidelines from different countries or different societies. These factors will have a certain impact on the judgment or choice of medical workers. The low compliance of patients is mainly due to the large number of drugs taken and the fear of new treatments. The use of fixed-dose combination therapies and polypill in clinical practice, the establishment of a new treatment system, and professional training for medical workers can reduce clinical inertia. In addition, patient education needs to be strengthened to improve patient compliance. Professor Vilma concluded that more and more evidence shows that fixed-dose combination therapy and polypill can reduce the types and dosages of drugs, simplify treatment plans, and help reduce drug interactions, further improving patient compliance and long-term treatment effects.

Adrianna Murphy教授：

政策实施中的壁垒和解决策略

来自英国伦敦卫生与热带医学学院的Adrianna Murphy教授首先介绍了复方药片的发展史，最早应追溯到2001年惠康基金会提出将复方药片用于二级预防，而目前最新定格在2023年世界卫生组织《基本药物清单》批准3种预防心血管疾病的固定剂量复方制剂（FDC）组合。但在推广固定剂量联合疗法和复方药片以降低心血管疾病死亡率的过程中，也会存在一定可用性、可及性以及可负担性的问题。具体涉及药物审批流程的复杂性、全球医疗资源分配不均以及患者用药意识和经济能力差异等关键障碍。Adrianna教授提出了针对这些壁垒的解决方案，包括支持提高本地制造能力、多区县或多国家之间的集中采购、将复方药片纳入国家基本药物目录、在处方集和临床指南中优先考虑、建立电子健康档案提供技术援助、加强指导医疗工作者的能力以及针对患者及社区进行宣教。最后，Adrianna教授强调解决方案离不开多层次利益相关者，如家庭、社区、医疗工作者以及各国和各地方政策制定者。

Professor Adrianna Murphy from the London School of Hygiene and Tropical Medicine first introduced the history of polypill, which can be traced back to 2001 when the Wellcome Trust proposed the use of compound tablets for secondary prevention. The latest date is 2023 when the World Health Organization's Essential Medicines List approved three fixed-dose combination preparations (FDC) for the prevention of cardiovascular disease. However, the problems of availability, accessibility, and affordability appear in the process of promoting fixed-dose combination therapies and compound tablets to reduce cardiovascular disease mortality. Specifically, key obstacles include the complexity of the drug approval process, the uneven distribution of global medical resources, and differences in patients' awareness of medication and economic capabilities. Professor Adrianna proposed solutions to these barriers, including supporting the improvement of local manufacturing capabilities, centralized procurement between multiple districts or countries, incorporating polypill into the national essential drug list, giving priority in prescriptions and clinical guidelines, establishing electronic health records to provide technical assistance, strengthening the ability to guide medical workers, and educating patients and communities. Finally, Professor Adrianna emphasized that solutions are inseparable from multi-level stakeholders, such as families, communities, medical workers, and national and local policymakers.

Pedro Orduñez教授：

纳入复方药片——美洲心脏治疗新策略

来自泛美卫生组织的Pedro Orduñez教授介绍了“全球心脏计划（HEARTS）”，旨为建立健康生活链，提高人群高血压控制水平和心血管疾病风险管理水平。Pedro教授引用一系列初级卫生设施和流行病学的数据，介绍了古巴和智利在初级卫生保健的经验，强调了区域适应和利用临床路径对初级卫生保健的重要性，通过标准培训和教育策略相结合，旨在改变在初级卫生环境中工作的人们的实践。Pedro教授强调，从传统的单一疗法到多药联合治疗高血压管理的过渡，需要相关部门推行并实施与方案一致的药品政策，从而使人们获得可负担的有效防治心血管疾病的复方药片。

Professor Pedro Orduñez from the Pan American Health Organization introduced the "Global Heart Program (HEARTS)", which aims to establish a healthy life chain and improve the level of hypertension control and cardiovascular disease risk management in the population. Professor Pedro cited a series of primary health facilities and epidemiological data, introduced the experience of Cuba and Chile in primary health care, emphasized the importance of regional adaptation and utilization of clinical pathways for primary health care, and aimed to change the practice of people working in primary health settings through a combination of standard training and education strategies. Professor Pedro emphasized that the transition from traditional monotherapy to polypill for the management of hypertension requires relevant departments to promote and implement consistent drug policies so that people can obtain affordable polypill, which prevents and treats cardiovascular diseases effectively.

本次论坛汇聚全球各地众多顶尖专家，共同探讨复方药片在心血管疾病防治领域的巨大潜力，以及在未来十年内显著降低心血管疾病死亡率的愿景与措施。本次论坛的成功举办，必将对全球心血管疾病防治工作带来新的启示，对推广固定剂量联合疗法和复方药片提供了积极推动力。

This forum brought together many top experts from around the world to discuss the huge potential of polypill in the prevention and treatment of cardiovascular diseases, as well as the vision and measures to significantly reduce cardiovascular disease mortality in the next decade. The successful holding of this forum will surely bring new inspiration to the global prevention and treatment of cardiovascular diseases and provide a positive impetus for the promotion of fixed-dose combination therapies and polypill.

审核：李新立