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@article{Selak:2018:10.1136/heartjnl-2018-313108,
author = {Selak, V and Webster, R and Stepien, S and Bullen, C and Patel, A and Thom, S and Arroll, B and Bots, ML and Brown, A and Crengle, S and Dorairaj, P and Elley, CR and Grobbee, DE and Harwood, M and Hillis, GS and Laba, T-L and Neal, BC and Peiris, D and Rafter, N and Reid, C and Stanton, A and Tonkin, A and Usherwood, T and Wadham, A and Rodgers, A},
doi = {10.1136/heartjnl-2018-313108},
journal = {Heart},
pages = {42--48},
title = {Reaching cardiovascular prevention guideline targets with a polypill-based approach: a meta-analysis of randomised clinical trials},
url = {http://dx.doi.org/10.1136/heartjnl-2018-313108},
volume = {105},
year = {2018}
}

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TY  - JOUR
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
AU  - Selak,V
AU  - Webster,R
AU  - Stepien,S
AU  - Bullen,C
AU  - Patel,A
AU  - Thom,S
AU  - Arroll,B
AU  - Bots,ML
AU  - Brown,A
AU  - Crengle,S
AU  - Dorairaj,P
AU  - Elley,CR
AU  - Grobbee,DE
AU  - Harwood,M
AU  - Hillis,GS
AU  - Laba,T-L
AU  - Neal,BC
AU  - Peiris,D
AU  - Rafter,N
AU  - Reid,C
AU  - Stanton,A
AU  - Tonkin,A
AU  - Usherwood,T
AU  - Wadham,A
AU  - Rodgers,A
DO  - 10.1136/heartjnl-2018-313108
EP  - 48
PY  - 2018///
SN  - 1355-6037
SP  - 42
TI  - Reaching cardiovascular prevention guideline targets with a polypill-based approach: a meta-analysis of randomised clinical trials
T2  - Heart
UR  - http://dx.doi.org/10.1136/heartjnl-2018-313108
UR  - https://heart.bmj.com/content/105/1/42
UR  - http://hdl.handle.net/10044/1/61841
VL  - 105
ER  -

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