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Original Article

JCDR. 2013; 4(2): 92-97


Effect of Pollypill on cardiovascular parameters: Systematic review and meta-analysis

Jaykaran Charan, Jagdish Prasad Goyal, Deepak Saxena.


Abstract

Background:Wald and law in their landmark paper published in BMJ in 2003 hypothesized that the use of
fixed dose combination of statins, beta blockers, angiotensin-converting-enzyme inhibitor (ACE) inhibitor,
and aspirin (Pollypill) may decrease cardiovascular disease by >80% if Pollypills are used as primary
prevention. Many clinical trials were started to test this hypothesis. The present systematic review and
meta-analysis aims to assess the available clinical trials to see the effect of Pollypill on cardiovascular
mortality and on other risk factors that linked with increase in cardiovascular events.
Materials and methods: Available databases were searched with different specific terms and combination
of key words. All randomized clinical trials exploring the effect of Pollypill on various cardiovascular
parameters were included in the analysis. Primary endpoints as decided were cardiovascular mortality,
systolic blood pressure, diastolic blood pressure, and low-density lipoprotein (LDL) cholesterol. Effect of
Pollypill on high-density lipoprotein (HDL) cholesterol, total cholesterol, triglycerides, the number of
participants who discontinued treatment, and the number of participants who experienced side effects
were measured and analyzed as secondary outcomes. Both fixed and random models were used for
analysis. Analysis was performed by comprehensive meta-analysis software.
Results: Six trials were included in systematic review. It was observed that Pollypill decreases systolic and
diastolic blood pressure (P ¼ 0.000). Pollypill was also found to decrease LDL cholesterol, total cholesterol,
and triglyceride as compared to the control (all P ¼ 0.000); however, there was no significant
improvement in HDL (P ¼ 0.39). The number of participants in whom side effects were observed were
found to be more in the Pollypill group (odds ratio ¼ 1.73, P ¼ 0.000). It was also observed that dropouts
were more in the Pollypill group than in the control group (odds ratio ¼ 1.48, P ¼ 0.02). Due to the lack of
sufficient data effect of Pollypill, cardiovascular mortality could not be assessed.
Conclusion: Pollypill decreases various surrogate endpoints related to cardiovascular outcome, but with
the increased chance of side effects as compared to control.

Key words: Clinical trials Diastolic blood pressure Low-density lipoprotein cholesterol Pollypill Systolic blood pressure






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