Abstract 14379: Polypill Therapy and Risk of Adverse Cardiovascular Events and Mortality: A Systematic Review and Meta-Analysis

Abstract

Introduction: Prior studies have reported improvements in population-level risk factor burden and cardiovascular outcomes using polypill strategy. We aimed to provide an updated meta-analysis of RCTs evaluating the efficacy of polypill-based strategy in reducing the risk of adverse cardiovascular outcomes. Methods: RCTs examining the association between polypill therapy and cardiovascular outcomes published before 2/1/2021 were included. The outcomes of interest were major adverse cardiovascular events (MACE) and all-cause mortality. Risk ratios for dichotomous outcomes were converted to log RR and pooled using a generic inverse variance weighted random-effects model. Data for continuous outcomes were pooled using random-effects modeling and presented as mean differences with 95% CIs. Results: Eight studies representing 25,584 patients were included for analysis. In pooled analysis, the use of polypills was associated with a non-significant reduction in the risk of MACE [RR(95% CI): 0.85(0.70-1.02)] and significant reductions in the risk of all-cause mortality [RR(95% CI): 0.90(0.81-1.00)]. The reductions in the risk of MACE with polypill use varied by baseline risk and nature of the study population [primary prevention (polypill, 476/10503; control, 684/10509) vs. secondary prevention (polypill, 170/2307; control, 153/2265)], with the most significant risk reduction among lower-risk cohorts, including within primary prevention populations [RR 0.70 (0.62, 0.79)]. Among CV risk factors, modest but significant reductions were observed for systolic and diastolic blood pressure, but not for levels of total or LDL-cholesterol. Polypill strategy was also associated with significantly improved drug adherence [RR(95% CI): 1.31(1.11-1.55)]. Conclusions: . Polypill strategy is associated with significant reductions in cardiovascular risk factors and the risk of all-cause mortality and MACE, particularly in the primary prevention population.