Abstract
Background: Single pills with fixed-dose combinations (FDC) of lipid and blood pressure lowering medications have been proposed for the treatment of cardiovascular disease. Although polypills have proven to be effective in secondary prevention of major cardiovascular events, there is a lack of evidence regarding polypill use in primary prevention in intermediate and high-risk patients. This systematic review and meta-analysis was conducted to evaluate the effect of polypills on primary prevention of cardiovascular (CV) events using data from clinical trials. Methods: We searched Pubmed, Web of Science, EBSCO, and SCOPUS through May 2021. Two authors independently screened articles for fulfillment of inclusion criteria. The RevMan (version 5.4) software was used to calculate the pooled risk ratios (RRs) and mean differences (MDs), along with their associated confidence intervals (95% CI). Results: Eight trials with a total of 20653 patients were included. There was a significant reduction in total fatal and non-fatal CV events among the polypill group [RR (95% CI) = 0.71 (0.63, 0.80); P < 0.001]. Moreover, this reduction was present for both the intermediate [RR (95% CI) = 0.76 (0.65, 0.89); P < 0.001] and high-risk [RR (95% CI) = 0.63 (0.52, 0.76); P < 0.001] group of patients. Subgroup analysis based on the follow up duration revealed this benefit was only evident in the five-year follow up duration group [RR (95% CI) = 0.70 (0.62, 0.79); P< 0.001] and was absent in the one-year or less interval group [RR (95% CI) = 0.77 (0.47, 1.29); P= 0.330]. Furthermore, there was a significant reduction in 10-year predicted cardiovascular risk in the polypill group [MD (95% CI) = -3.74 (-5.96, -1.51); P< 0.001] compared to controls. Conclusion: A polypill strategy decreases the incidence of fatal and non-fatal CV events in patients with intermediate and high cardiovascular risk and may be an effective component in the care of these patients.
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