Efficacy of different polypill combinations for primary and secondary cardiovascular disease prevention: a systematic review and meta-analysis
Abstract
Background Cardiovascular disease is the leading cause of mortality and morbidity worldwide, and polypills have established efficacy in preventing poor outcomes. However, evidence on the optimal polypill combination is lacking. The objective of the study is to estimate the optimal polypill combination that maximizes cardiovascular outcomes. Methods MEDLINE/PubMed, Scopus, and Cochrane Database of Systematic Reviews databases were searched from January 1, 1960, to March 30, 2025. Studies that provided data on the association between polypill and cardiovascular outcomes were included. We estimated the effect of various polypill combinations by random-effects meta-analyses using the generic inverse variance method. Subgroup and meta-regression analyses were conducted to explore potential effect modification in the association between polypill combinations and cardiovascular outcomes. Results Thirty studies comprising 35,833 individuals met the inclusion criteria from 6 continents. The estimated pooled effects of polypill use on major adverse cardiovascular events (MACE), cardiovascular death, and all-cause mortality were RR 0.78 (95% CI, 0.63–0.97), 0.75 (95% CI, 0.63–0.89), 0.88 (95% CI, 0.79–0.98), respectively. The pooled relative risk of MACE outcome was 21% lower in combination of 4 or more pills [0.79 (95% CI, 0.55–1.15), n = 6 studies] vs. to 22% and 3 or less combination of medication classes (RR: 0.78 95% CI: 0.70–0.86), n = 4 studies). Polypill combinations containing…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 35,833 participants or records.
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