Reaching cardiovascular prevention guideline targets with a polypill-based approach: A meta-Analysis of randomised clinical trials

Vanessa Selak, Ruth Webster, Sandrine Stepien, Chris Bullen, Anushka Patel, Simon Thom, Bruce Arroll, Michiel L. Bots, Alex Brown, Sue Crengle, Prabhakaran Dorairaj, C. Raina Elley, Diederick E. Grobbee, Matire Harwood, Graham S. Hillis, Tracey Lea Laba, Bruce Neal, David Peiris, Natasha Rafter, Christopher Reid & 5 others Alice Stanton, Andrew Tonkin, Tim Usherwood, Angela Wadham, Anthony Rodgers

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective The aim of this study was to determine the effect of polypill-based care on the achievement of 2016 European Society of Cardiology (ESC) guideline targets for blood pressure (BP), low-density lipoprotein (LDL) cholesterol and antiplatelet therapy. Methods We conducted an individual participant data meta-Analysis of three randomised clinical trials that compared a strategy using a polypill containing aspirin, statin and antihypertensive therapy with usual care in patients with a prior cardiovascular disease (CVD) event or who were at high risk of their first event. Overall, the trials included 3140 patients from Australia, England, India, Ireland, the Netherlands and New Zealand (75% male, mean age 62 years and 76% with a prior CVD event). The primary outcome for this study was the proportion of people achieving ESC guideline targets for BP, LDL and antiplatelet therapy. Results Those randomised to polypill-based care were more likely than those receiving usual care to achieve recommended targets for BP (62% vs 58%, risk ratio (RR) 1.08, 95% CI 1.02 to 1.15), LDL (39% vs 34%, RR 1.13, 95% CI 1.02 to 1.25) and all three targets for BP, LDL and adherence to antiplatelet therapy (the latter only applicable to those with a prior CVD event) simultaneously (24% vs 19%, RR 1.27, 95% CI 1.10 to 1.47) at 12 months. There was no difference between groups in antiplatelet adherence (96% vs 96%, RR 1.00, 95% CI 0.98 to 1.01). There was heterogeneity by baseline treatment intensity such that treatment effects increased with the fewer the number of treatments being taken at baseline: for patients taking 3, 2 and 0-1 treatment modalities the RRs for reaching all three guideline goals simultaneously were 1.10 (95% CI 0.94 to 1.30, 22% vs 20%), 1.62 (95% CI 1.09 to 2.42, 27% vs 17%) and 3.07 (95% CI 1.77 to 5.33, 35% vs 11%), respectively. Conclusions Polypill-based therapy significantly improved the achievement of all three ESC targets for BP, LDL and antiplatelet therapy compared with usual care, particularly among those undertreated at baseline.

LanguageEnglish
Pages42-48
Number of pages7
JournalHeart
Volume105
Issue number1
DOIs
Publication statusPublished - 1 Jan 2019

Keywords

  • cardiac risk factors and prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Selak, Vanessa ; Webster, Ruth ; Stepien, Sandrine ; Bullen, Chris ; Patel, Anushka ; Thom, Simon ; Arroll, Bruce ; Bots, Michiel L. ; Brown, Alex ; Crengle, Sue ; Dorairaj, Prabhakaran ; Elley, C. Raina ; Grobbee, Diederick E. ; Harwood, Matire ; Hillis, Graham S. ; Laba, Tracey Lea ; Neal, Bruce ; Peiris, David ; Rafter, Natasha ; Reid, Christopher ; Stanton, Alice ; Tonkin, Andrew ; Usherwood, Tim ; Wadham, Angela ; Rodgers, Anthony. / Reaching cardiovascular prevention guideline targets with a polypill-based approach : A meta-Analysis of randomised clinical trials. In: Heart. 2019 ; Vol. 105, No. 1. pp. 42-48.
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title = "Reaching cardiovascular prevention guideline targets with a polypill-based approach: A meta-Analysis of randomised clinical trials",
abstract = "Objective The aim of this study was to determine the effect of polypill-based care on the achievement of 2016 European Society of Cardiology (ESC) guideline targets for blood pressure (BP), low-density lipoprotein (LDL) cholesterol and antiplatelet therapy. Methods We conducted an individual participant data meta-Analysis of three randomised clinical trials that compared a strategy using a polypill containing aspirin, statin and antihypertensive therapy with usual care in patients with a prior cardiovascular disease (CVD) event or who were at high risk of their first event. Overall, the trials included 3140 patients from Australia, England, India, Ireland, the Netherlands and New Zealand (75{\%} male, mean age 62 years and 76{\%} with a prior CVD event). The primary outcome for this study was the proportion of people achieving ESC guideline targets for BP, LDL and antiplatelet therapy. Results Those randomised to polypill-based care were more likely than those receiving usual care to achieve recommended targets for BP (62{\%} vs 58{\%}, risk ratio (RR) 1.08, 95{\%} CI 1.02 to 1.15), LDL (39{\%} vs 34{\%}, RR 1.13, 95{\%} CI 1.02 to 1.25) and all three targets for BP, LDL and adherence to antiplatelet therapy (the latter only applicable to those with a prior CVD event) simultaneously (24{\%} vs 19{\%}, RR 1.27, 95{\%} CI 1.10 to 1.47) at 12 months. There was no difference between groups in antiplatelet adherence (96{\%} vs 96{\%}, RR 1.00, 95{\%} CI 0.98 to 1.01). There was heterogeneity by baseline treatment intensity such that treatment effects increased with the fewer the number of treatments being taken at baseline: for patients taking 3, 2 and 0-1 treatment modalities the RRs for reaching all three guideline goals simultaneously were 1.10 (95{\%} CI 0.94 to 1.30, 22{\%} vs 20{\%}), 1.62 (95{\%} CI 1.09 to 2.42, 27{\%} vs 17{\%}) and 3.07 (95{\%} CI 1.77 to 5.33, 35{\%} vs 11{\%}), respectively. Conclusions Polypill-based therapy significantly improved the achievement of all three ESC targets for BP, LDL and antiplatelet therapy compared with usual care, particularly among those undertreated at baseline.",
keywords = "cardiac risk factors and prevention",
author = "Vanessa Selak and Ruth Webster and Sandrine Stepien and Chris Bullen and Anushka Patel and Simon Thom and Bruce Arroll and Bots, {Michiel L.} and Alex Brown and Sue Crengle and Prabhakaran Dorairaj and Elley, {C. Raina} and Grobbee, {Diederick E.} and Matire Harwood and Hillis, {Graham S.} and Laba, {Tracey Lea} and Bruce Neal and David Peiris and Natasha Rafter and Christopher Reid and Alice Stanton and Andrew Tonkin and Tim Usherwood and Angela Wadham and Anthony Rodgers",
year = "2019",
month = "1",
day = "1",
doi = "10.1136/heartjnl-2018-313108",
language = "English",
volume = "105",
pages = "42--48",
journal = "Heart",
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Selak, V, Webster, R, Stepien, S, Bullen, C, Patel, A, Thom, S, Arroll, B, Bots, ML, Brown, A, Crengle, S, Dorairaj, P, Elley, CR, Grobbee, DE, Harwood, M, Hillis, GS, Laba, TL, Neal, B, Peiris, D, Rafter, N, Reid, C, Stanton, A, Tonkin, A, Usherwood, T, Wadham, A & Rodgers, A 2019, 'Reaching cardiovascular prevention guideline targets with a polypill-based approach: A meta-Analysis of randomised clinical trials', Heart, vol. 105, no. 1, pp. 42-48. https://doi.org/10.1136/heartjnl-2018-313108

Reaching cardiovascular prevention guideline targets with a polypill-based approach : A meta-Analysis of randomised clinical trials. / Selak, Vanessa; Webster, Ruth; Stepien, Sandrine; Bullen, Chris; Patel, Anushka; Thom, Simon; Arroll, Bruce; Bots, Michiel L.; Brown, Alex; Crengle, Sue; Dorairaj, Prabhakaran; Elley, C. Raina; Grobbee, Diederick E.; Harwood, Matire; Hillis, Graham S.; Laba, Tracey Lea; Neal, Bruce; Peiris, David; Rafter, Natasha; Reid, Christopher; Stanton, Alice; Tonkin, Andrew; Usherwood, Tim; Wadham, Angela; Rodgers, Anthony.

In: Heart, Vol. 105, No. 1, 01.01.2019, p. 42-48.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Reaching cardiovascular prevention guideline targets with a polypill-based approach

T2 - Heart

AU - Selak, Vanessa

AU - Webster, Ruth

AU - Stepien, Sandrine

AU - Bullen, Chris

AU - Patel, Anushka

AU - Thom, Simon

AU - Arroll, Bruce

AU - Bots, Michiel L.

AU - Brown, Alex

AU - Crengle, Sue

AU - Dorairaj, Prabhakaran

AU - Elley, C. Raina

AU - Grobbee, Diederick E.

AU - Harwood, Matire

AU - Hillis, Graham S.

AU - Laba, Tracey Lea

AU - Neal, Bruce

AU - Peiris, David

AU - Rafter, Natasha

AU - Reid, Christopher

AU - Stanton, Alice

AU - Tonkin, Andrew

AU - Usherwood, Tim

AU - Wadham, Angela

AU - Rodgers, Anthony

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective The aim of this study was to determine the effect of polypill-based care on the achievement of 2016 European Society of Cardiology (ESC) guideline targets for blood pressure (BP), low-density lipoprotein (LDL) cholesterol and antiplatelet therapy. Methods We conducted an individual participant data meta-Analysis of three randomised clinical trials that compared a strategy using a polypill containing aspirin, statin and antihypertensive therapy with usual care in patients with a prior cardiovascular disease (CVD) event or who were at high risk of their first event. Overall, the trials included 3140 patients from Australia, England, India, Ireland, the Netherlands and New Zealand (75% male, mean age 62 years and 76% with a prior CVD event). The primary outcome for this study was the proportion of people achieving ESC guideline targets for BP, LDL and antiplatelet therapy. Results Those randomised to polypill-based care were more likely than those receiving usual care to achieve recommended targets for BP (62% vs 58%, risk ratio (RR) 1.08, 95% CI 1.02 to 1.15), LDL (39% vs 34%, RR 1.13, 95% CI 1.02 to 1.25) and all three targets for BP, LDL and adherence to antiplatelet therapy (the latter only applicable to those with a prior CVD event) simultaneously (24% vs 19%, RR 1.27, 95% CI 1.10 to 1.47) at 12 months. There was no difference between groups in antiplatelet adherence (96% vs 96%, RR 1.00, 95% CI 0.98 to 1.01). There was heterogeneity by baseline treatment intensity such that treatment effects increased with the fewer the number of treatments being taken at baseline: for patients taking 3, 2 and 0-1 treatment modalities the RRs for reaching all three guideline goals simultaneously were 1.10 (95% CI 0.94 to 1.30, 22% vs 20%), 1.62 (95% CI 1.09 to 2.42, 27% vs 17%) and 3.07 (95% CI 1.77 to 5.33, 35% vs 11%), respectively. Conclusions Polypill-based therapy significantly improved the achievement of all three ESC targets for BP, LDL and antiplatelet therapy compared with usual care, particularly among those undertreated at baseline.

AB - Objective The aim of this study was to determine the effect of polypill-based care on the achievement of 2016 European Society of Cardiology (ESC) guideline targets for blood pressure (BP), low-density lipoprotein (LDL) cholesterol and antiplatelet therapy. Methods We conducted an individual participant data meta-Analysis of three randomised clinical trials that compared a strategy using a polypill containing aspirin, statin and antihypertensive therapy with usual care in patients with a prior cardiovascular disease (CVD) event or who were at high risk of their first event. Overall, the trials included 3140 patients from Australia, England, India, Ireland, the Netherlands and New Zealand (75% male, mean age 62 years and 76% with a prior CVD event). The primary outcome for this study was the proportion of people achieving ESC guideline targets for BP, LDL and antiplatelet therapy. Results Those randomised to polypill-based care were more likely than those receiving usual care to achieve recommended targets for BP (62% vs 58%, risk ratio (RR) 1.08, 95% CI 1.02 to 1.15), LDL (39% vs 34%, RR 1.13, 95% CI 1.02 to 1.25) and all three targets for BP, LDL and adherence to antiplatelet therapy (the latter only applicable to those with a prior CVD event) simultaneously (24% vs 19%, RR 1.27, 95% CI 1.10 to 1.47) at 12 months. There was no difference between groups in antiplatelet adherence (96% vs 96%, RR 1.00, 95% CI 0.98 to 1.01). There was heterogeneity by baseline treatment intensity such that treatment effects increased with the fewer the number of treatments being taken at baseline: for patients taking 3, 2 and 0-1 treatment modalities the RRs for reaching all three guideline goals simultaneously were 1.10 (95% CI 0.94 to 1.30, 22% vs 20%), 1.62 (95% CI 1.09 to 2.42, 27% vs 17%) and 3.07 (95% CI 1.77 to 5.33, 35% vs 11%), respectively. Conclusions Polypill-based therapy significantly improved the achievement of all three ESC targets for BP, LDL and antiplatelet therapy compared with usual care, particularly among those undertreated at baseline.

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DO - 10.1136/heartjnl-2018-313108

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