474 Effects of fixed-dose combination therapy for prevention of cardiovascular disease uncertain

January 04, 2016

written by Brian R McAvoy

Clinical question
How effective is fixed-dose combination therapy (also known as a polypill) for the prevention of cardiovascular disease (CVD)?

Bottom line
Compared with usual care, active control or placebo for CVD prevention, the effects of fixed-dose combination therapy (FDCT – blood pressure, cholesterol lowering and antiplatelet therapies) on all-cause mortality or CVD events were uncertain due to low event rates, imprecision and risk of bias. Only a few trials reported these outcomes, and the included trials were primarily designed to observe changes in CVD risk factor levels rather than clinical events. FDCT was associated with lower blood pressure and lipid levels, though substantial heterogeneity of results existed. FDCT was associated with modest increases in adverse events compared with placebo, single-drug active component or usual care, but might be associated with improved adherence to a multidrug regimen.

Caveat
The effects on quality of life were uncertain, and no cost data were reported. The heterogeneity might reflect differences in primary compared with secondary prevention studies, the composition of fixed-dose combinations, comparator groups or all of the above. Several trials are ongoing.

Context
CVD is the leading cause of death and disability worldwide, yet CVD risk factor control and secondary prevention rates remain low. A fixed-dose combination of blood pressure and cholesterol-lowering and antiplatelet treatments into a single pill, or polypill, has been proposed as one strategy to reduce the global burden of CVD by up to 80%, given its potential for better adherence and lower costs.

Cochrane Systematic Review
de Cates AN et al. Fixed-dose combination therapy for the prevention of cardiovascular disease. Cochrane Reviews, 2014, Issue 4. Art. No.: CD009868.DOI: 10.1002/14651858. CD009868.pub2. This review contains 9 studies involving 7047 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.