Polypills Approach for Multiple Cardiovascular Risk Factors (PACIF) : a Multicentre, Open-label, Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 8,252
- 试验地点
- 12
- 主要终点
- 10-year CVD risk
研究概览
简要总结
The Polypill Approach for Multiple Cardiovascular Risk Factors (PACIF) trial is a multicenter randomized controlled trial that will test the effectiveness and safety of a fixed-dose combination strategy for integrated management of hypertension, dyslipidemia, and diabetes among adults aged 50 to 75 years in China. The trial will evaluate whether a simplified regimen combining blood pressure-lowering, lipid-lowering, and glucose-lowering therapy improves the 10-year cardiovascular disease risk score at phase 1. Participants will be followed to determine whether the fixed-dose combination strategy reduces major cardiovascular events and cognitive function compared with usual care at phase 2.
详细描述
The overall objective of the PACIF Trial is to test a fixed-dose combination strategy for the integrated management of hypertension, dyslipidemia, and diabetes. This multicenter randomized controlled trial will evaluate whether a polypill-based approach, compared with usual care, improves cardiovascular risk factor control and reduces cardiovascular disease events among adults with multiple cardiovascular risk factors. The trial will recruit an estimated 8,252 participants aged 50 to 75 years who have hypertension, dyslipidemia, and diabetes. Participants will be randomly assigned to receive either a fixed-dose combination strategy or usual care. In the intervention group, the study medication regimen will consist of six fixed-dose formulations, including three antihypertensive formulations, two lipid-lowering formulations, and one glucose-lowering formulation. The antihypertensive component will be titrated using prespecified dose combinations, including olmesartan medoxomil/amlodipine and indapamide, until the blood pressure target is achieved. Lipid-lowering therapy will be initiated with rosuvastatin plus ezetimibe, with dose reduction of the rosuvastatin component in participants who are intolerant to the initial statin dose. Glucose-lowering therapy will include dapagliflozin as the prespecified study medication. Treatment targets are defined as systolic blood pressure <130 mmHg and diastolic blood pressure <80 mmHg, LDL cholesterol <1.8 mmol/L, and HbA1c <7.0%. The primary outcome at phase 1 is the ACC/AHA 10-year cardiovascular disease risk estimated by the PREVENT equations. In addition, the proportions of participants achieving the prespecified blood pressure, lipid, and glycemic targets will also be evaluated. The primary outcome at phase 2 is composite cardiovascular disease events, including myocardial infarction, stroke, heart failure requiring hospitalization or treatment, or cardiovascular death. Cognitive function will also be assessed, with incident dementia prespecified as a major secondary endpoint.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
盲法说明
Outcome Assessment Committee members will be blinded to outcome assignment.
入排标准
- 年龄范围
- 50 Years 至 75 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Men or women
- •Age ≥50 years and <75 years
- •Hypertension, defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg among participants not currently taking antihypertensive medication, or systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg among participants currently taking any antihypertensive medication
- •Dyslipidemia, defined as LDL-C ≥1.8 mmol/L (70 mg/dL)
- •Type 2 diabetes with HbA1c ≥6.5% and <12%
- •Willing to participate and able to sign informed consent
排除标准
- •Known secondary cause of hypertension
- •Type 1 diabetes
- •Pancreatic insufficiency or diabetes secondary to pancreatitis
- •Triglycerides ≥5.65 mmol/L (500 mg/dL)
- •History of coronary, carotid, or cerebrovascular revascularization within the previous 12 months
- •History of myocardial infarction or stroke within the previous 6 months
- •NYHA class III-IV heart failure at entry or hospitalization for exacerbation of chronic heart failure within the previous 6 months
- •Abnormal kidney function, defined as estimated glomerular filtration rate <30 mL/min/1.73 m² or dialysis
- •Abnormal liver function, defined as alanine aminotransferase or aspartate aminotransferase >3 times the upper limit of normal
- •Abnormal serum potassium, defined as serum potassium >5.5 mmol/L or <3.5 mmol/L
- •Contraindication to any of the components of the polypill
- •Currently living with another PACIF participant
- •Pregnancy, currently trying to become pregnant, or of child-bearing potential and not using birth control
- •Clinical diagnosis of dementia or treatment with medications for dementia
- •History of malignancy
- •Life expectancy <3 years
- •Currently participating in another intervention study
- •Any factors judged by the clinic team to be likely to limit adherence to interventions
结局指标
主要结局
10-year CVD risk
时间窗: 12 months
Changes in 10-year CVD risk estimated by the PREVENT equations
Composite cardiovascular disease outcome
时间窗: 36 months
Record the occurrence of newly diagnosed composite cardiovascular disease
次要结局
- The proportion of patients achieved blood pressure target(12 months)
- 10-year ASCVD risk(12 months)
- 10-year HF risk(12 months)
- Major secondary endpoint: All-cause dementia(36 months)
- The proportion of patients achieved LDL-C target(12 months)
- The proportion of patients achieved HbA1c target(12 months)
- The proportion of patients achieved all three targets (blood pressure, LDL-C, and HbA1c)(12 months)
- Blood pressure(12 months)
- LDL-C(12 months)
- HbA1c(12 months)
- Medication adherence(12 months)
- Cost-effectiveness(12 months)
- The proportion of patients achieved blood pressure target(36 months)
- The proportion of patients achieved LDL-C target(36 months)
- The proportion of patients achieved HbA1c target(36 months)
- The proportion of patients achieved all three targets (blood pressure, LDL-C, and HbA1c)(36 months)
- Blood pressure(36 months)
- LDL-C(36 months)
- HbA1c(36 months)
- Composite outcome of composite cardiovascular disease outcome or deaths(36 months)
- Heart failure requiring hospitalization or treatment(36 months)
- Macrovascular outcome(36 months)
- Major coronary artery diseases(36 months)
- Myocardial infarction(36 months)
- Stroke(36 months)
- Ischemic stroke(36 months)
- Hemorrhagic stoke(36 months)
- Cardiovascular disease death(36 months)
- All-cause death(36 months)
- Aortic dissection(36 months)
- Cancer(36 months)
- New-onset chronic kidney disease or progression of chronic kidney disease(36 months)
- Medication adherence(36 months)
- Mild cognitive impairment(36 months)
- Composite outcome of dementia and mild cognitive impairment(36 months)
- Health related quality of life(36 months)
- Cost-effectiveness(36 months)
研究者
Guozhe Sun
Deputy Chief of the Department of Cardiology, First Hospital of China Medical University
First Hospital of China Medical University