Cardiovascular risk lowering during therapy with an SPC amlodipine/atorvastatin/ perindopril: post-hoc analysis of TARGET study results

Abstract

The Objective of the study was to describe the effect of the single-pill combination (SPC) of amlodipine/atorvastatin/perindopril on cardiovascular (CV) risk calculated by SCORE scale in terms of 12-week observational study TARGET Material and methods. One hundred and three patients out of 409 ambulatory patients with arterial hypertension (HTN) and dyslipidemia from the TARGET study (NCT03722524) were included in the post-hoc analysis. Those patients had no atherosclerotic cardiovascular diseases (ASCVD), diabetes mellitus, chronic kidney disease or family heterozygous hypercholesterolemia, so their CV risk could be calculated by SCORE scale according to the Russian clinical recommendations on HTN from 2020. Patients were treated with the SPC of amlodipine/atorvastatin/perindopril in dosage strength 5/10/5, 5/20/5 or 5/20/10 mg once daily. Assessment by SCORE scale took place on the baseline visit (Visit 0), on the 4-th (Visit 1) and 12 th weeks of the observation period (Visit 2). Uniand multivariate regression models were used to define significant predictors of CV risk change according to SCORE scale. Results. Median age of the patients was 55.0 (50.5–60.0) years, men and women were equally represented, while 81.6% of the patients were overweight/obese and 64.1% smoked. The objective calculation and physicians’ evaluation of the SCORE risk coincided only in 21.6% cases on the Visit and in 52.9% on the Visit 2. Median CV risk assessed by SCORE decreased from 4.6 (1.7–8.6) at baseline visit to 2.6 (0.8–4.7) by week 4 and to 1.7 (0.7–3.6) by week 12 (both р<0.0001) during treatment with the SPC amlodipine/atorvastatin/perindopril. CV risk decrease was observed in all subgroups of patients regardless of the SPC dosage without any significant intergroup differences. The proportion of patients with low/moderate CV risk increased from 50.9% to 94.1% by the end of the follow-up period. Only achievement of the target blood pressure (BP) level of <140/90 mm Hg by Visit 2 was significantly associated with CV risk decrease in terms of multifactorial regression model. Conclusion. Treatment with the SPC of amlodipine/atorvastatin/perindopril was accompanied by significant decrease of CV risk assessed by SCORE already by week 4 aintaining the effect by week 12 of the follow-up period in patients without ASCVD regardless of the SPC dosage. CV risk descrease was significantly associated with target BP achievement of <140/90 mm Hg which highlights the key role of BP control in the overall strategy of CV risk mitigation and demonstrates potential advantages of this multitarget polypill in real clinical practice.