03174nas a2200385   4500000000100000008004100001100001500042700001800057700002200075700001700097700001700114700002000131700001800151700001500169700001800184700002100202700002500223700002100248700001800269700001900287700001700306700001700323700001800340700001500358700001800373700001700391700001600408700001800424700001900442700001800461700002000479245013600499520213900635022001402774       2018                            d1 aThom Simon1 aStanton Alice1 aGrobbee Diederick1 aBots Michiel1 aWebster Ruth1 aLaba Tracey-Lea1 aHillis Graham1 aBrown Alex1 aUsherwood Tim1 aStepien Sandrine1 aDorairaj Prabhakaran1 aReid Christopher1 aTonkin Andrew1 aRafter Natasha1 aPeiris David1 aBullen Chris1 aSelak Vanessa1 aNeal Bruce1 aPatel Anushka1 aArroll Bruce1 aCrengle Sue1 aC Elley Raina1 aHarwood Matire1 aWadham Angela1 aRodgers Anthony00aReaching cardiovascular prevention guideline targets with a polypill-based approach: a meta-analysis of randomised clinical trials.3 a<p><b>OBJECTIVE: </b>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.</p><p><b>METHODS: </b>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.</p><p><b>RESULTS: </b>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.</p><p><b>CONCLUSIONS: </b>Polypill-based therapy significantly improved the achievement of all three ESC targets for BP, LDL and antiplatelet therapy compared with usual care, particularly among those undertreated at baseline.</p>  a1468-201X