Fixed-dose combination therapy for the prevention of atherosclerotic cardiovascular disease
© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc..
Fixed-dose combination (FDC) therapy, also known as polypill therapy, targets risk factors for atherosclerotic cardiovascular disease (ASCVD) and has been proposed as a strategy to reduce global ASCVD burden. Here we conducted a systematic search for relevant studies from 2016-2022 to assess the effects of FDC therapy for prevention of ASCVD. The studies selected include randomized trials evaluating FDC therapy with at least one blood pressure-lowering drug and one lipid-lowering drug. The study data were independently extracted, the quality of evidence was appraised by multiple reviewers and effect estimates were pooled using a fixed-effect meta-analysis when statistical heterogeneity was low to moderate. The main outcomes of the analysis were all-cause mortality, fatal and nonfatal ASCVD events, adverse events, systolic blood pressure, low-density lipoprotein cholesterol and adherence. Among 26 trials (n = 27,317 participants, 43.2% female and mean age range 52.9-76.0), FDC therapy was associated with lower low-density lipoprotein cholesterol and systolic blood pressure, with higher rates of adherence and adverse events in both primary and mixed secondary prevention populations. For studies with a mostly primary prevention population, FDC therapy was associated with lower risk of all-cause mortality by 11% (5.6% versus 6.3%; relative risk (risk ratio) of 0.89; 95% confidence interval 0.78 to 1.00; I2 = 0%; four trials and 16,278 participants) and risk of fatal and nonfatal ASCVD events by 29% (6.1% versus 8.4%; relative risk (risk ratio) of 0.71; 95% confidence interval 0.63 to 0.79; I2 = 0%; five trials and 15,503 participants). One adequately powered trial in an exclusively secondary prevention population showed that FDC therapy reduced the risk of major adverse cardiovascular events by 24%. These findings support adoption and implementation of polypills to lower risk for all-cause mortality and ASCVD.
Medienart: |
E-Artikel |
---|
Erscheinungsjahr: |
2024 |
---|---|
Erschienen: |
2024 |
Enthalten in: |
Zur Gesamtaufnahme - volume:30 |
---|---|
Enthalten in: |
Nature medicine - 30(2024), 4 vom: 27. Apr., Seite 1199-1209 |
Sprache: |
Englisch |
---|
Beteiligte Personen: |
Agarwal, Anubha [VerfasserIn] |
---|
Links: |
---|
Themen: |
---|
Anmerkungen: |
Date Completed 22.04.2024 Date Revised 26.04.2024 published: Print-Electronic Citation Status MEDLINE |
---|
doi: |
10.1038/s41591-024-02896-w |
---|
funding: |
|
---|---|
Förderinstitution / Projekttitel: |
|
PPN (Katalog-ID): |
NLM370217780 |
---|
LEADER | 01000caa a22002652 4500 | ||
---|---|---|---|
001 | NLM370217780 | ||
003 | DE-627 | ||
005 | 20240426234018.0 | ||
007 | cr uuu---uuuuu | ||
008 | 240328s2024 xx |||||o 00| ||eng c | ||
024 | 7 | |a 10.1038/s41591-024-02896-w |2 doi | |
028 | 5 | 2 | |a pubmed24n1388.xml |
035 | |a (DE-627)NLM370217780 | ||
035 | |a (NLM)38532223 | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a eng | ||
100 | 1 | |a Agarwal, Anubha |e verfasserin |4 aut | |
245 | 1 | 0 | |a Fixed-dose combination therapy for the prevention of atherosclerotic cardiovascular disease |
264 | 1 | |c 2024 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a ƒaComputermedien |b c |2 rdamedia | ||
338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
500 | |a Date Completed 22.04.2024 | ||
500 | |a Date Revised 26.04.2024 | ||
500 | |a published: Print-Electronic | ||
500 | |a Citation Status MEDLINE | ||
520 | |a © 2024. The Author(s), under exclusive licence to Springer Nature America, Inc. | ||
520 | |a Fixed-dose combination (FDC) therapy, also known as polypill therapy, targets risk factors for atherosclerotic cardiovascular disease (ASCVD) and has been proposed as a strategy to reduce global ASCVD burden. Here we conducted a systematic search for relevant studies from 2016-2022 to assess the effects of FDC therapy for prevention of ASCVD. The studies selected include randomized trials evaluating FDC therapy with at least one blood pressure-lowering drug and one lipid-lowering drug. The study data were independently extracted, the quality of evidence was appraised by multiple reviewers and effect estimates were pooled using a fixed-effect meta-analysis when statistical heterogeneity was low to moderate. The main outcomes of the analysis were all-cause mortality, fatal and nonfatal ASCVD events, adverse events, systolic blood pressure, low-density lipoprotein cholesterol and adherence. Among 26 trials (n = 27,317 participants, 43.2% female and mean age range 52.9-76.0), FDC therapy was associated with lower low-density lipoprotein cholesterol and systolic blood pressure, with higher rates of adherence and adverse events in both primary and mixed secondary prevention populations. For studies with a mostly primary prevention population, FDC therapy was associated with lower risk of all-cause mortality by 11% (5.6% versus 6.3%; relative risk (risk ratio) of 0.89; 95% confidence interval 0.78 to 1.00; I2 = 0%; four trials and 16,278 participants) and risk of fatal and nonfatal ASCVD events by 29% (6.1% versus 8.4%; relative risk (risk ratio) of 0.71; 95% confidence interval 0.63 to 0.79; I2 = 0%; five trials and 15,503 participants). One adequately powered trial in an exclusively secondary prevention population showed that FDC therapy reduced the risk of major adverse cardiovascular events by 24%. These findings support adoption and implementation of polypills to lower risk for all-cause mortality and ASCVD | ||
650 | 4 | |a Meta-Analysis | |
650 | 4 | |a Journal Article | |
650 | 7 | |a Cholesterol, LDL |2 NLM | |
700 | 1 | |a Mehta, Priya M |e verfasserin |4 aut | |
700 | 1 | |a Jacobson, Tyler |e verfasserin |4 aut | |
700 | 1 | |a Shah, Nilay S |e verfasserin |4 aut | |
700 | 1 | |a Ye, Jiancheng |e verfasserin |4 aut | |
700 | 1 | |a Zhu, JingJing |e verfasserin |4 aut | |
700 | 1 | |a Wafford, Q Eileen |e verfasserin |4 aut | |
700 | 1 | |a Bahiru, Ehete |e verfasserin |4 aut | |
700 | 1 | |a de Cates, Angharad N |e verfasserin |4 aut | |
700 | 1 | |a Ebrahim, Shah |e verfasserin |4 aut | |
700 | 1 | |a Prabhakaran, Dorairaj |e verfasserin |4 aut | |
700 | 1 | |a Rodgers, Anthony |e verfasserin |4 aut | |
700 | 1 | |a Huffman, Mark D |e verfasserin |4 aut | |
773 | 0 | 8 | |i Enthalten in |t Nature medicine |d 1995 |g 30(2024), 4 vom: 27. Apr., Seite 1199-1209 |w (DE-627)NLM074659804 |x 1546-170X |7 nnns |
773 | 1 | 8 | |g volume:30 |g year:2024 |g number:4 |g day:27 |g month:04 |g pages:1199-1209 |
856 | 4 | 0 | |u http://dx.doi.org/10.1038/s41591-024-02896-w |3 Volltext |
912 | |a GBV_USEFLAG_A | ||
912 | |a GBV_NLM | ||
951 | |a AR | ||
952 | |d 30 |j 2024 |e 4 |b 27 |c 04 |h 1199-1209 |