Benefits of the Polypill on Medication Adherence in the Primary and Secondary Prevention of Cardiovascular Disease: A Systematic Review
Jose P Lopez-Lopez,1,2,* Ana Maria Gonzalez,1,* Paola Lanza,1 Patricio Lopez-Jaramillo1 1MASIRA Research Institute, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia; 2Department of Internal Medicine. Cardiology Unit, Hospital Universitario San Ignacio, Pontificia Uni...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2023-09-01
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| Series: | Vascular Health and Risk Management |
| Subjects: | |
| Online Access: | https://www.dovepress.com/benefits-of-the-polypill-on-medication-adherence-in-the-primary-and-se-peer-reviewed-fulltext-article-VHRM |
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| author | Lopez-Lopez JP Gonzalez AM Lanza P Lopez-Jaramillo P |
| author_facet | Lopez-Lopez JP Gonzalez AM Lanza P Lopez-Jaramillo P |
| author_sort | Lopez-Lopez JP |
| collection | DOAJ |
| description | Jose P Lopez-Lopez,1,2,* Ana Maria Gonzalez,1,* Paola Lanza,1 Patricio Lopez-Jaramillo1 1MASIRA Research Institute, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia; 2Department of Internal Medicine. Cardiology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia*These authors contributed equally to this workCorrespondence: Patricio Lopez-Jaramillo, MASIRA Research Institute, Facultad de Ciencias de la Salud, Universidad de Santander (UDES), Bloque G, piso 6, Bucaramanga, Santander, Colombia, Tel +57 315 306 8939, Email jplopezj@gmail.comBackground: Higher medication adherence reduces the risk of new cardiovascular events. However, there are individual and health system barriers that lead to lower adherence. The polypill has demonstrated benefits in cardiovascular morbidity and mortality mainly driven by an increase in adherence. We aim to evaluate the impact of the polypill on adherence to cardiovascular medication, its efficacy and safety in cardiovascular disease (CVD) prevention.Methods: A systematic review following PRISMA guidelines was conducted. Databases were searched from January 2003 to December 2022. We included randomized, pragmatic, or real-world clinical trials and observational studies. The primary outcome was medication adherence, secondary outcomes were efficacy in cardiovascular disease in primary and secondary prevention and safety.Results: From the 490 publications screened, 13 met the inclusion criteria and were incorporated into a comparative table Of those included, 70% were randomized controlled trials (RCTs) and 53.8% focused on secondary prevention. Most of the studies received a high and moderate quality rating. Self-report, pill counting and, the Morisky scale were the most frequent methods to evaluate adherence (84.6%). Compared with standard medication, the polypill improved overall medication adherence by 13%, with percentages ranging from 7.6% to 34.9%. Moreover, a potential benefit was also observed in reducing Major Adverse Cardiovascular Events (MACE), particularly in secondary prevention studies, with hazard ratios ranged between 0.43 to 0.76. Compared to standard care, the profile of side effects was similar.Conclusion: The polypill is an effective, safe, and practical strategy to improve adherence in people at risk of CVD. Although there is a demonstrated benefit in reducing MACE, predominantly in secondary prevention, there are still gaps in its efficacy in primary prevention and reducing total mortality. Therefore, the importance of obtaining long-term results of the polypill effect and how this strategy can be implemented in real practice.Keywords: polypill, cardiovascular disease, hypertension, dyslipidemia, major cardiovascular events |
| first_indexed | 2024-03-12T00:45:21Z |
| format | Article |
| id | doaj.art-a4cf742465cc44279cb4901baeb4ec20 |
| institution | Directory Open Access Journal |
| issn | 1178-2048 |
| language | English |
| last_indexed | 2024-03-12T00:45:21Z |
| publishDate | 2023-09-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Vascular Health and Risk Management |
| spelling | doaj.art-a4cf742465cc44279cb4901baeb4ec202023-09-14T19:09:03ZengDove Medical PressVascular Health and Risk Management1178-20482023-09-01Volume 1960561586633Benefits of the Polypill on Medication Adherence in the Primary and Secondary Prevention of Cardiovascular Disease: A Systematic ReviewLopez-Lopez JPGonzalez AMLanza PLopez-Jaramillo PJose P Lopez-Lopez,1,2,* Ana Maria Gonzalez,1,* Paola Lanza,1 Patricio Lopez-Jaramillo1 1MASIRA Research Institute, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia; 2Department of Internal Medicine. Cardiology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia*These authors contributed equally to this workCorrespondence: Patricio Lopez-Jaramillo, MASIRA Research Institute, Facultad de Ciencias de la Salud, Universidad de Santander (UDES), Bloque G, piso 6, Bucaramanga, Santander, Colombia, Tel +57 315 306 8939, Email jplopezj@gmail.comBackground: Higher medication adherence reduces the risk of new cardiovascular events. However, there are individual and health system barriers that lead to lower adherence. The polypill has demonstrated benefits in cardiovascular morbidity and mortality mainly driven by an increase in adherence. We aim to evaluate the impact of the polypill on adherence to cardiovascular medication, its efficacy and safety in cardiovascular disease (CVD) prevention.Methods: A systematic review following PRISMA guidelines was conducted. Databases were searched from January 2003 to December 2022. We included randomized, pragmatic, or real-world clinical trials and observational studies. The primary outcome was medication adherence, secondary outcomes were efficacy in cardiovascular disease in primary and secondary prevention and safety.Results: From the 490 publications screened, 13 met the inclusion criteria and were incorporated into a comparative table Of those included, 70% were randomized controlled trials (RCTs) and 53.8% focused on secondary prevention. Most of the studies received a high and moderate quality rating. Self-report, pill counting and, the Morisky scale were the most frequent methods to evaluate adherence (84.6%). Compared with standard medication, the polypill improved overall medication adherence by 13%, with percentages ranging from 7.6% to 34.9%. Moreover, a potential benefit was also observed in reducing Major Adverse Cardiovascular Events (MACE), particularly in secondary prevention studies, with hazard ratios ranged between 0.43 to 0.76. Compared to standard care, the profile of side effects was similar.Conclusion: The polypill is an effective, safe, and practical strategy to improve adherence in people at risk of CVD. Although there is a demonstrated benefit in reducing MACE, predominantly in secondary prevention, there are still gaps in its efficacy in primary prevention and reducing total mortality. Therefore, the importance of obtaining long-term results of the polypill effect and how this strategy can be implemented in real practice.Keywords: polypill, cardiovascular disease, hypertension, dyslipidemia, major cardiovascular eventshttps://www.dovepress.com/benefits-of-the-polypill-on-medication-adherence-in-the-primary-and-se-peer-reviewed-fulltext-article-VHRMpolypillcardiovascular diseasehypertensiondyslipidemiamajor cardiovascular events |
| spellingShingle | Lopez-Lopez JP Gonzalez AM Lanza P Lopez-Jaramillo P Benefits of the Polypill on Medication Adherence in the Primary and Secondary Prevention of Cardiovascular Disease: A Systematic Review Vascular Health and Risk Management polypill cardiovascular disease hypertension dyslipidemia major cardiovascular events |
| title | Benefits of the Polypill on Medication Adherence in the Primary and Secondary Prevention of Cardiovascular Disease: A Systematic Review |
| title_full | Benefits of the Polypill on Medication Adherence in the Primary and Secondary Prevention of Cardiovascular Disease: A Systematic Review |
| title_fullStr | Benefits of the Polypill on Medication Adherence in the Primary and Secondary Prevention of Cardiovascular Disease: A Systematic Review |
| title_full_unstemmed | Benefits of the Polypill on Medication Adherence in the Primary and Secondary Prevention of Cardiovascular Disease: A Systematic Review |
| title_short | Benefits of the Polypill on Medication Adherence in the Primary and Secondary Prevention of Cardiovascular Disease: A Systematic Review |
| title_sort | benefits of the polypill on medication adherence in the primary and secondary prevention of cardiovascular disease a systematic review |
| topic | polypill cardiovascular disease hypertension dyslipidemia major cardiovascular events |
| url | https://www.dovepress.com/benefits-of-the-polypill-on-medication-adherence-in-the-primary-and-se-peer-reviewed-fulltext-article-VHRM |
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