TY - JOUR AU - Selak V. AU - Arroll B. AU - Rafter N. AU - Bramley D. AU - Bullen C. AU - Thom S. AU - Grobbee D. AU - Tonkin A. AU - Usherwood T. AU - Webster R. AU - Cass A. AU - Wadham A. AU - Hillis G. AU - Molanus B. AU - Bots M. AU - Stepien S. AU - Rodgers A AU - Neal Bruce AU - Patel Anushka AB -

AIM: The aim of this study was to investigate whether polypill-based care for the prevention of cardiovascular disease (CVD) is associated with a change in lifestyle risk factors when compared with usual care, among patients with CVD or high calculated cardiovascular risk. METHODS: We conducted an individual participant data meta-analysis of three trials including patients from Australia, England, India, Ireland, the Netherlands and New Zealand that compared a strategy using a polypill containing aspirin, statin and antihypertensive therapy with usual care in patients with a prior CVD event or who were at high risk of their first event. Analyses investigated any differential effect on anthropometric measures and self-reported lifestyle behaviours. RESULTS: Among 3140 patients (75% male, mean age 62 years and 76% with a prior CVD event) there was no difference in lifestyle risk factors in those randomised to polypill-based care compared with usual care over a median of 15 months, either across all participants combined, or in a range of subgroups. Furthermore, narrow confidence intervals (CIs) excluded any major effect; for example differences between the groups in body mass index was -0.1 (95% CI -0.2 to 0.1) kg/m2, in weekly duration of moderate intensity physical activity was -2 (-26 to 23) minutes and the proportion of smokers was 16% vs 17% (RR 0.98, 0.84 to 1.15) at the end of trial. DISCUSSION: This analysis allays concern that polypill-based care may lead to neglect of lifestyle risk factors, at least among high-risk patients. Maximally effective preventive approaches should address lifestyle factors alongside pharmaceutical interventions, as recommended by major international guidelines.

AD - Department of Epidemiology and Biostatistics, University of Auckland, New Zealand v.selak@auckland.ac.nz.
National Institute for Health Innovation, University of Auckland, New Zealand.
The George Institute for Global Health, University of Sydney, Australia.
Department of General Practice and Primary Health Care, University of Auckland, New Zealand.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
Waitemata District Health Board, New Zealand.
Menzies School of Health Research, Charles Darwin University, Australia.
Department of Cardiology, Royal Perth Hospital, Australia.
South Australian Health and Medical Research Institute, Australia.
National Institute for Health Innovation, University of Auckland, New Zealand Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Ireland.
International Centre for Circulatory Health, Imperial College London, UK.
Department of Epidemiology and Preventive Medicine, Monash University, Australia.
Department of General Practice, University of Sydney Westmead, Australia. AN - 26945024 BT - European Journal of Preventive Cardiology DP - NLM ET - 2016/03/06 LA - Eng LB - AUS
FP
OCS
PROF
R&M
FY16 N1 - Selak, Vanessa
Bullen, Chris
Stepien, Sandrine
Arroll, Bruce
Bots, Michiel
Bramley, Dale
Cass, Alan
Grobbee, Diederick
Hillis, Graham S
Molanus, Barbara
Neal, Bruce
Patel, Anushka
Rafter, Natasha
Rodgers, Anthony
Thom, Simon
Tonkin, Andrew
Usherwood, Tim
Wadham, Angela
Webster, Ruth
Eur J Prev Cardiol. 2016 Mar 4. pii: 2047487316638216. N2 -

AIM: The aim of this study was to investigate whether polypill-based care for the prevention of cardiovascular disease (CVD) is associated with a change in lifestyle risk factors when compared with usual care, among patients with CVD or high calculated cardiovascular risk. METHODS: We conducted an individual participant data meta-analysis of three trials including patients from Australia, England, India, Ireland, the Netherlands and New Zealand that compared a strategy using a polypill containing aspirin, statin and antihypertensive therapy with usual care in patients with a prior CVD event or who were at high risk of their first event. Analyses investigated any differential effect on anthropometric measures and self-reported lifestyle behaviours. RESULTS: Among 3140 patients (75% male, mean age 62 years and 76% with a prior CVD event) there was no difference in lifestyle risk factors in those randomised to polypill-based care compared with usual care over a median of 15 months, either across all participants combined, or in a range of subgroups. Furthermore, narrow confidence intervals (CIs) excluded any major effect; for example differences between the groups in body mass index was -0.1 (95% CI -0.2 to 0.1) kg/m2, in weekly duration of moderate intensity physical activity was -2 (-26 to 23) minutes and the proportion of smokers was 16% vs 17% (RR 0.98, 0.84 to 1.15) at the end of trial. DISCUSSION: This analysis allays concern that polypill-based care may lead to neglect of lifestyle risk factors, at least among high-risk patients. Maximally effective preventive approaches should address lifestyle factors alongside pharmaceutical interventions, as recommended by major international guidelines.

PY - 2016 SN - 2047-4881 (Electronic)
2047-4873 (Linking) T2 - European Journal of Preventive Cardiology TI - Do polypills lead to neglect of lifestyle risk factors? Findings from an individual participant data meta-analysis among 3140 patients at high risk of cardiovascular disease VL - pii: 2047487316638216 Y2 - FY16 ER -