Polypill for cardiovascular disease prevention: Systematic review and meta-analysis of randomized controlled trials.

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. 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). 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/m2. 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]. 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. • 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. [ABSTRACT FROM AUTHOR]