• Ruth Webster, Anushka Patel, Vanessa Selak, Laurent Billot, Michiel L Bots, Alex Brown, Chris Bullen, Alan Cass, Sue Crengle, Raina ElleyCCDepartment of General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand., Diederick E Grobbee, Bruce Neal, David Peiris, Neil Poulter, Dorairaj Prabhakaran, Natasha Rafter, Alice Stanton, Sandrine Stepien, Simon Thom, Tim Usherwood, Angela Wadham, Anthony Rodgers, and SPACE Collaboration.
• The George Institute for Global Health, University of Sydney, PO Box M201, Missenden Rd, Camperdown, NSW 2050, Australia. Electronic address: rwebster@georgeinstitute.org.au.
• Int. J. Cardiol. 2016 Feb 15; 205: 147-156.

AimsTo conduct a prospective, individual participant data (IPD) meta-analysis of randomised controlled trials comparing a polypill-based approach with usual care in high risk individuals.Methods And ResultsThree trials comparing polypill-based care with usual care in individuals with CVD or high calculated cardiovascular risk contributed IPD. Primary outcomes were self-reported adherence to combination therapy (anti-platelet, statin and ≥ two blood pressure (BP) lowering agents), and difference in mean systolic BP (SBP) and LDL-cholesterol at 12 months. Analyses used random effects models. Among 3140 patients from Australia, England, India, Ireland, New Zealand and The Netherlands (75% male, mean age 62 years), median follow-up was 15 months. At baseline, 84%, 87% and 61% respectively were taking a statin, anti-platelet agent and at least two BP lowering agents. At 12 months, compared to usual care, participants in the polypill arm had higher adherence to combination therapy (80% vs. 50%, RR 1.58; 95% CI, 1.32 to 1.90; p < 0.001), lower SBP (-2.5 mmHg; 95% CI, -4.5 to -0.4; p = 0.02) and lower LDL-cholesterol (-0.1 mmol/L; 95% CI, -0.2 to 0.0; p = 0.04). Baseline treatment levels were a major effect modifier for adherence and SBP (p-homog < 0.0001 and 0.02 respectively) with greatest improvements seen among those under-treated at baseline.ConclusionsPolypill therapy significantly improved adherence, SBP and LDL-cholesterol in high risk patients compared with usual care, especially among those who were under-treated at baseline.Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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