Polypill for cardiovascular disease prevention: Systematic review and meta-analysis of randomized controlled trials. (1st August 2022)

• Record Type: Journal Article
• Authors: Mohamed, MohamedM.G.; Osman, Mohammed; Kheiri, Babikir; Saleem, Maryam; Lacasse, Alexandre; Alkhouli, Mohamad
• Is Part Of: International journal of cardiology. Volume 360(2022)
• Page Start: 91
• Page End: 98
• Publication Date: 2022-08-01
• Subjects: Polypill -- Hypertension -- Dyslipidemia -- Cardiovascular prevention; ACEI angiotensin-converting enzyme inhibitor -- AE adverse events -- ARB angiotensin receptor blocker -- BB beta-blocker -- CCB calcium channel blocker -- CI confidence interval -- CVD mortality cardiovascular mortality -- CVD cardiovascular disease -- DBP diastolic blood pressure -- ESC European society of cardiology -- GBD global burden of disease -- IQR interquartile range -- LDL-C low-density lipoprotein -- MACE major adverse cardiovascular events -- MD mean difference -- MI myocardial infarction -- PROSPERO International Prospective Register of Systematic Reviews -- RCT Randomized controlled trial -- RR risk ratio -- SBP systolic blood pressure -- TC total cholesterol; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.04.085
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Cardiovascular disease is the leading cause of death worldwide. Although many pharmacological agents exist, drug compliance and therapeutic goal achievement continue to be suboptimal. This meta-analysis aims to study the effectiveness of polypills in controlling blood pressure, dyslipidemia and in reducing future cardiovascular events. Methods: We conducted a systematic search of electronic databases using pre-specified terms. Randomized clinical trials (RCT) comparing polypills (statin, antihypertensive agents, with or without aspirin) with the standard of care were included. Outcomes of interest were changes in [systolic blood pressure (SBP), diastolic blood pressure (DBP)] mmHg, [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C)] mg/dl, cardiovascular (CVD) mortality, and major adverse cardiovascular events (MACE). Results: A total of 18 RCTs with 26, 483 participants were included. The population had 55% males, with a mean age of 61.8 ± 7 years, and a mean BMI of 26.7 ± 4.2 kg/m 2 . The mean follow-up was 15.0 ± 20 months . Compared with standard of care, polypill use was associated with a significant reduction of SBP (Mean Difference [MD] -6.39; [95%CI -9.21, −3.56] p < 0.001), DBP (MD -4.19, [95%CI -5.48, −2.89; p < 0.001], TC (MD -24.95, [95%CI -33.86, −16.04]; p < 0.001), and LDL-C (MD -27.92, [95%CI -35.39, −20.44]; p < 0.001). Polypill use was also associated with a significant reduction of CVD mortality (RR = 0.78; 95% CI (0.61, 0.99); P = 0.04) and MACE [RR = 0.76;95% CI (0.64, 0.91); P = 0.002]. Conclusion: This meta-analysis showed that compared to standard of care, polypill use was associated with a significant reduction of SBP, DBP, TC, LDL-C, and a significant reduction in fatal and non-fatal cardiovascular events. Highlights: Cardiovascular disease remains the leading cause of morbidity and mortality. Hypertension and dyslipidemia control leads to optimal cardiovascular outcomes. Taking multiple pills a day represent a burden and a challenge to most patients. Polypills might represent a promising strategy to optimize control and adherence. Our study examined the effect of polypills on cardiovascular outcomes and adherence.