Polypill cuts risk of cardiovascular disease but not mortality

Use of a fixed-dose combination therapy or a polypill effectively lowers cardiovascular risk factors but falls short of producing significant reductions in mortality, according to a systematic review and meta-analysis.

Researchers searched multiple online databases for randomized trials that examined the efficacy of antihypertensive and lipid-lowering ± antiplatelet drug combinations in populations at risk of cardiovascular disease. The search yielded 16 trials, which comprised 26,567 participants in total, for inclusion in the meta-analysis.

Pooled data showed that compared with control, the drug combinations examined conferred no clinically meaningful benefit for all-cause mortality (risk ratio [RR], 0.90, 95 percent confidence interval [CI], 0.79–1.01; I², 0 percent; moderate certainty) and major adverse cardiac events (RR, 0.84, 95 percent CI, 0.68–1.04; I², 51 percent; very low certainty). Results were similar in a subgroup analysis of studies that used an active control.

On the other hand, polypills produced significant reductions in major adverse cardiac event risk in studies that exclusively targeted primary prevention, followed patients for ≥4 years, and had a low risk of bias.

Compared with the control group, the polypill group was associated with markedly greater adherence (RR, 1.18, 95 percent CI, 1.06–1.32; I², 96 percent; very low certainty) and similar rates of adverse side effects (RR, 1.10, 95 percent CI, 0.98–1.23; I², 58 percent; moderate certainty). Of note, patients randomized to the polypill achieved significant reductions in systolic and diastolic blood pressure, as well as in total and low-density lipoprotein cholesterol levels.

More studies are needed to validate the clinical benefits of polypills and determine the patient populations likely to achieve such benefits.