Efficacy and Safety of a polypill to reduce cardiovascular events: A review of clinical trials.

Cardiovascular disease continues to be the leading cause of mortality globally. Modifiable risk factors, such as hypertension and dyslipidemia can be managed through lifestyle and pharmacotherapy treatments to reduce the risk of primary and secondary major cardiovascular events in patients with elevated risk. Despite effective and available medications to manage and mitigate cardiovascular risk factors, control rates of hypertension and dyslipidemia are suboptimal and greater efforts are needed to reduce cardiovascular event rates worldwide. A polypill containing several classes of medications proven to lower cardiovascular risk in a single dose form has been associated with improved medication adherence over multiple single-ingredient medications and may lead to reduced cardiovascular events. The goal of this article is to review available data from clinical trials assessing the efficacy and safety of polypills compared to placebo or usual care for cardiovascular risk reduction. Three databases were searched (PubMed/Medline, CINAHL, ScienceDirect) for randomized trials that compared a single polypill to usual care or placebo, and reported major adverse cardiovascular events (MACE) for each study group. A total of 6 trials were selected for inclusion. Several polypill formulations were compared to placebo or usual care with multiple single-ingredient medications in study populations consisting of both primary and secondary prevention patients. Overall, the polypill appears to be associated with reduced MACE and comparable safety to usual care treatment with an added benefit of improved adherence over multiple single-ingredient medications. The polypill has potential to be a cost-effective intervention to reduce the global burden of cardiovascular disease.