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. 2022 Apr 14:9:880054.
doi: 10.3389/fcvm.2022.880054. eCollection 2022.

Polypills for Primary Prevention of Cardiovascular Disease: A Systematic Review and Meta-Analysis

Omneya A Kandil  1 , Karam R Motawea  1 , Merna M Aboelenein  1 , Jaffer Shah  2
Affiliations

Polypills for Primary Prevention of Cardiovascular Disease: A Systematic Review and Meta-Analysis

Omneya A Kandil et al. Front Cardiovasc Med. .

Abstract

Purpose: To evaluate the effect of polypills on the primary prevention of cardiovascular (CV) events using data from clinical trials.

Methods: We searched PubMed, Web of Science, EBSCO, and SCOPUS throughout May 2021. Two authors independently screened articles for the fulfillment of inclusion criteria. The RevMan software (version 5.4) 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 the total number of fatal and non-fatal CV events among the polypill group [RR (95% CI) = 0.71 (0.63, 0.80); P-value < 0.001]. This reduction was observed in both the intermediate-risk [RR (95% CI) = 0.76 (0.65, 0.89); P-value < 0.001] and high-risk [RR (95% CI) = 0.63 (0.52, 0.76); P-value < 0.001] groups of patients. Subgroup analysis was performed based on the follow-up duration of each study, and benefits were only evident in the five-year follow-up duration group [RR (95% CI) = 0.70 (0.62, 0.79); P-value < 0.001]. Benefits were absent in the one-year-or-less interval group [RR (95% CI) = 0.77 (0.47, 1.29); P-value = 0.330]. Additionally, there was a significant reduction in the 10-year predicted cardiovascular risk in the polypill group [MD (95% CI) = -3.74 (-5.96, -1.51); P-value < 0.001], as compared to controls.

Conclusion: A polypill regimen decreases the incidence of fatal and non-fatal CV events in patients with intermediate- and high- cardiovascular risk, and therefore may be an effective treatment for these patients.

Keywords: antihypertensives; cardiovascular events; lipid-lowering; polypill; primary prevention.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Risk of bias assessment and graph.
Figure 3
Figure 3
Forest plot of total fatal and non-fatal CV events.
Figure 4
Figure 4
Forest plot of the 12-months-or-less and 5-year follow-up subgroup analysis.
Figure 5
Figure 5
Forest plot according to risk stratification: intermediate and high-risk patients subgroup analysis.
Figure 6
Figure 6
Forest plot of the difference in the 10-year predicted cardiovascular risk.
Figure 7
Figure 7
Forest plot of the total adverse events.
Figure 8
Figure 8
Forest plot of treatment discontinuation due to adverse events.
Figure 9
Figure 9
Forest plot of myalgia.
See this image and copyright information in PMC

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