如何讓心臟病人按時吃藥？一顆複方製劑搞定

Heart disease kills more people than any other condition, but despite advances in treatment and prevention, patients often do not stick to their medication regimens. Now researchers may have found a solution: a so-called polypill that combines three drugs needed to prevent cardiovascular trouble.

死於心臟病的人比死於其他任何疾病的人都多，儘管在治療和預防上取得進展，患者往往不能堅守他們的藥物治療方式。現在，研究人員可能已經找到一個解決方法：一種混合三種預防心血管疾病所需藥物的所謂複方製劑。

In what is apparently the largest and longest randomized controlled trial of this approach, patients who were prescribed a polypill within six months of a heart attack were more likely to keep taking their drugs and had significantly fewer cardiovascular events, compared with those receiving the usual assortment of pills.

在明顯是這種方法規模最大、時間最長的隨機對照試驗中，心臟病發作後6個月內服用複方製劑的患者，跟服用常規藥物患者相比，更有可能繼續服用藥物，心血管事件明顯減少。

The participants also experienced one-third fewer cardiovascular deaths, although their overall risk of death from all causes was not significantly changed.

參與者因心血管疾病死亡人數也減少三分之一，即便他們因為各種原因死亡的總體風險沒有顯著改變。

The study of more than 2,000 heart patients, who were followed for three years, was published Friday morning in The New England Journal of Medicine, as the findings were presented at the European Society of Cardiology Congress in Barcelona, Spain.

這項研究對2000多名心臟病患者進行三年追蹤調查，研究結果周五上午發表在《新英格蘭醫學雜誌》，並在西班牙巴塞隆納舉行的歐洲心臟病學會年會上發表。

The study is the culmination of 15 years of work by researchers led by Dr. Valentin Fuster, director of Mount Sinai Heart at Mount Sinai Hospital in New York City and general director of the National Center for Cardiovascular Research in Spain.

這研究是紐約市西奈山醫院西奈山心臟中心主任、西班牙國立心血管研究中心總監瓦倫丁．福斯特博士帶領研究人員研究15年的結晶。

“Combination pills are easier for the physician and for the patient, and the data are pretty clear — it translates into a benefit,” said Dr. Thomas J. Wang, chair of the department of internal medicine at UT Southwestern Medical Center, who was not involved in the research but wrote an editorial accompanying the study.

未參與研究但為研究報告撰寫社評的德州大學西南醫學中心內科系主任湯瑪斯．王博士說：「複方藥物對醫生和病患來說更簡便，數據非常清楚，它轉化為一種好處。」

The polypill combines a blood-pressure medication, a cholesterol-lowering drug and aspirin, which helps prevent blood clots.

這種複方製劑結合了降壓藥、降膽固醇藥和阿斯匹林，有助防止血栓。

The polypill used in the study has not been approved by the Food and Drug Administration and is not available to patients in the United States right now. Fuster said the results of the new trial would be submitted to the agency shortly in an effort to obtain approval.

這項研究使用的複方製劑還未獲得美國食品藥物管理局批准，目前在美國還不能給患者使用。福斯特說，這項新試驗結果很快會提交給該機構，以爭取獲得批准。

And since participants became even more likely to keep taking the polypill over time, he said, “The potential results could be even better with more follow-up.” Several studies have shown that only about half of patients, or even less, take all their medications as instructed.

他說，由於參與者會逐漸的更可能繼續服用複方製劑，「若有更多後續研究，潛在結果可能更好」。數項研究顯示，只有大約一半甚至更少患者按照指示服用所有藥物。

The new study, a randomized controlled clinical trial, enrolled just under 2,500 patients at 113 sites in Spain, Italy, France, Germany, Poland, the Czech Republic and Hungary.

這項研究是一項隨機對照臨床試驗，在西班牙、義大利、法國、德國、波蘭、捷克和匈牙利的113個地點招募到近2500名患者。

期中選舉前 拜登不再妥協火力全開

President Joe Biden likes to say there is nothing America cannot do if the country is united and its rival parties are willing to work together.

美國總統拜登喜歡說，只要美國團結一致，敵對的政黨願意合作，美國就沒有做不成的事。

But with just two months until the midterm elections, Biden is purposely spending less time hailing the virtues of compromise and more time calling out dangers to democracy — using some of the sharpest and most combative language of his presidency.

然而，如今距離期中選舉只有兩個月，拜登故意少花時間讚揚妥協的優點，卻花更多時間疾呼民主面臨的危險，使用他總統任期內最尖銳、最好鬥的措辭。

He has accused Republicans of embracing “semi-fascism” by paying fealty to former President Donald Trump. He has blasted the party for being “full of anger, violence, hate and division.” And he has warned that the danger from Republicans loyal to Trump went far beyond differences in policy.

他指責共和黨人對前總統川普表示忠誠，是在擁抱「半法西斯主義」。他抨擊共和黨「充滿憤怒、暴力、仇恨和分裂」。他還警告，共和黨人忠於川普帶來的危險，遠遠超出政策歧見。

“They’re a threat to our very democracy,” he said of a party that he has spent a half-century working with to find common ground. “They refuse to accept the will of the people. They embrace political violence.”

對於這個他花了半世紀尋求共識的政黨，他說：「他們是對我們民主的威脅。他們拒絕接受人民的意願。 他們擁抱政治暴力」。

After weeks of internal White House strategy sessions, the president and his aides have devised a confrontational election-season approach that focuses on Biden’s accomplishments coupled with an aggressive political assault on the GOP, including the poll-tested phrase he began using this spring: “ultra-MAGA Republicans.”

經過數周的白宮內部戰略會議，拜登總統和他的幕僚們設計了一種對抗性的選舉季手法，把重點放在拜登的成就以及對共和黨進行猛烈的政治攻擊，包括今年春天他開始使用、經過民調考驗的名詞：「極端『讓美國再次偉大』共和黨人」。

Now, with Trump once again at the center of a criminal investigation, this time over his handling of classified documents, Biden has seized the moment to press a case that voters cannot risk a return to a party in the thrall of the former president.

現在，隨著川普再次成為刑事調查中心，這次是因為他對機密文件的處理，拜登抓住這個時機，力促選民不要冒險重回一個受前總統束縛的政黨懷抱。

“After a successful past couple of months, the president and Democrats have effectively turned this midterm into a choice, when it’s typically a referendum on the party in the White House,” said Stephanie Cutter, a veteran Democratic strategist. “The president now is articulating that choice, pretty damned well and at just the right time.”

資深民主黨策士史蒂芬妮．卡特說：「在過去幾個月的成功後，總統和民主黨人實際上已將這次期中選舉變成一個選擇，而期中選舉通常是對執掌白宮政黨公投。總統現在在正確的時間，非常準確地闡明這個選擇。」

She added, “The choice couldn’t be clearer — a reminder of what people rejected just two years ago.”

她還說：「這個選擇再清楚不過了，提醒人們兩年前拒絕了什麼。」

Biden is leaning into more political attacks, aides and allies said, in part because of what he sees as a growing embrace of violent political speech by Republicans and a threat to the democratic process of governing. The aides said he was dismayed by the number of Trump-backed election deniers who have won Republican primaries for governor or secretary of state across the country.

拜登幕僚和盟友說，拜登正傾向發動更多政治攻擊，部分係因他認為共和黨人日益傾向發表暴力政治言論，威脅治理的民主過程。幕僚們說，川普支持的否認總統大選者，不少人在全國各地共和黨州長或州務卿初選獲勝，拜登對此感到失望。

Biden, whose own approval ratings have begun to improve slightly since lows earlier this summer, is hoping that his party can maintain control of Congress and deliver a forceful rebuke to Trump and his followers.

拜登的支持率已從今夏稍早低點開始略有上升，他希望他的政黨能繼續控制國會，對川普及其支持者傳達有力的斥責。