{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T03:35:56Z","timestamp":1791516956681,"version":"4.3.4"},"reference-count":40,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2018,5,24]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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%\u2009CI 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\u20131 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2018-313108","type":"journal-article","created":{"date-parts":[[2018,6,28]],"date-time":"2018-06-28T12:20:01Z","timestamp":1530188401000},"page":"42-48","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":55,"title":["Reaching cardiovascular prevention guideline targets with a polypill-based approach: a meta-analysis of randomised clinical trials"],"prefix":"10.1136","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9824-8674","authenticated-orcid":false,"given":"Vanessa","family":"Selak","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7444-3037","authenticated-orcid":false,"given":"Ruth","family":"Webster","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandrine","family":"Stepien","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Bullen","sequence":"additional","affiliation":[{"name":"National Institute for Health Innovation, University of Auckland, Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anushka","family":"Patel","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Thom","sequence":"additional","affiliation":[{"name":"International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Arroll","sequence":"additional","affiliation":[{"name":"Department of General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiel L","family":"Bots","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Brown","sequence":"additional","affiliation":[{"name":"South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Crengle","sequence":"additional","affiliation":[{"name":"Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prabhakaran","family":"Dorairaj","sequence":"additional","affiliation":[{"name":"Centre for Chronic Disease Control, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C Raina","family":"Elley","sequence":"additional","affiliation":[{"name":"Department of General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diederick E","family":"Grobbee","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matire","family":"Harwood","sequence":"additional","affiliation":[{"name":"Te Kupenga Hauora M\u0101ori, University of Auckland, Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham S","family":"Hillis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracey-Lea","family":"Laba","sequence":"additional","affiliation":[{"name":"Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Neal","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Peiris","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Rafter","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Reid","sequence":"additional","affiliation":[{"name":"School of Public Health, Curtin University, Perth, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Stanton","sequence":"additional","affiliation":[{"name":"Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Tonkin","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Usherwood","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia"},{"name":"Department of General Practice, Sydney Medical School Westmead, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Wadham","sequence":"additional","affiliation":[{"name":"National Institute for Health Innovation, University of Auckland, Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Rodgers","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,6,28]]},"reference":[{"key":"2025092012195569000_105.1.42.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw106"},{"key":"2025092012195569000_105.1.42.2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487315569401"},{"key":"2025092012195569000_105.1.42.3","doi-asserted-by":"publisher","DOI":"10.1177\/2047487312444995"},{"key":"2025092012195569000_105.1.42.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.12.015"},{"key":"2025092012195569000_105.1.42.5","doi-asserted-by":"crossref","first-page":"119-177","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur Heart J"},{"key":"2025092012195569000_105.1.42.6","doi-asserted-by":"publisher","DOI":"10.1097\/01.hjh.0000431740.32696.cc"},{"key":"2025092012195569000_105.1.42.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.10.007"},{"key":"2025092012195569000_105.1.42.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g3318"},{"key":"2025092012195569000_105.1.42.9","doi-asserted-by":"publisher","DOI":"10.1177\/2047487314530382"},{"key":"2025092012195569000_105.1.42.10","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.277064"},{"key":"2025092012195569000_105.1.42.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2011.07.006"},{"key":"2025092012195569000_105.1.42.12","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-10-458","article-title":"Rationale and design of the Kanyini guidelines adherence with the polypill (Kanyini-GAP) study: a randomised controlled trial of a polypill-based strategy amongst indigenous and non indigenous people at high cardiovascular risk","volume":"10","author":"Liu","year":"2010","journal-title":"BMC Public Health"},{"key":"2025092012195569000_105.1.42.13","doi-asserted-by":"publisher","DOI":"10.1177\/2047487312463278"},{"key":"2025092012195569000_105.1.42.14","unstructured":"New Zealand Guidelines Group. New Zealand cardiovascular guidelines handbook. Wellington: New Zealand Guidelines Group, 2005."},{"key":"2025092012195569000_105.1.42.15","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.768986"},{"key":"2025092012195569000_105.1.42.16","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1993.03500210079036"},{"key":"2025092012195569000_105.1.42.17","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.16.1798"},{"key":"2025092012195569000_105.1.42.18","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0060650","article-title":"Individual participant data meta-analysis for a binary outcome: one-stage or two-stage?","volume":"8","author":"Debray","year":"2013","journal-title":"PLoS One"},{"key":"2025092012195569000_105.1.42.19","unstructured":"National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. CG68. London: NICE, 2008."},{"key":"2025092012195569000_105.1.42.20","unstructured":"National Institute for Health and Care Excellence. Hypertension in adults: diagnosis and management. CG12. London: NICE, 2011."},{"key":"2025092012195569000_105.1.42.21","unstructured":"National Institute for Health and Care Excellence. Peripheral arterial disease: diagnosis and management. CG147. London: NICE, 2012."},{"key":"2025092012195569000_105.1.42.22","unstructured":"National Institute for Health and Care Excellence. Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease. CG172. London: NICE, 2013."},{"key":"2025092012195569000_105.1.42.23","unstructured":"National Institute for Health and Care Excellence. Secondary prevention of coronary heart disease. Indicator ID NM118. 2015 https:\/\/www.nice.org.uk\/Media\/Default\/Standards-and-indicators\/QOF_Indicator_Key_documents\/nm118-chd-guidance.pdf (accessed 15 Sep 2017)."},{"key":"2025092012195569000_105.1.42.24","doi-asserted-by":"publisher","DOI":"10.1161\/HYP.0000000000000066"},{"key":"2025092012195569000_105.1.42.25","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318235eb4d"},{"key":"2025092012195569000_105.1.42.26","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.284427"},{"key":"2025092012195569000_105.1.42.27","doi-asserted-by":"publisher","DOI":"10.1097\/01.hjr.0000277984.31558.c4"},{"key":"2025092012195569000_105.1.42.28","first-page":"21","article-title":"Dispensing data captures individual-level use of aspirin for cardiovascular disease prevention, despite availability over-the-counter","volume":"129","author":"Selak","year":"2016","journal-title":"N Z Med J"},{"key":"2025092012195569000_105.1.42.29","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1177\/2047487317695616","article-title":"Impact of switching from different treatment regimens to a fixed-dose combination pill (polypill) in patients with cardiovascular disease or similarly high risk","volume":"24","author":"Lafeber","year":"2017","journal-title":"Eur J Prev Cardiol"},{"key":"2025092012195569000_105.1.42.30","doi-asserted-by":"publisher","DOI":"10.1177\/2047487316647827"},{"key":"2025092012195569000_105.1.42.31","first-page":"39","article-title":"Effect of age, gender, ethnicity, socioeconomic status and region on dispensing of CVD secondary prevention medication in New Zealand: the Atlas of Health Care Variation CVD cohort (VIEW-1)","volume":"127","author":"Kerr","year":"2014","journal-title":"N Z Med J"},{"key":"2025092012195569000_105.1.42.32","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/S0140-6736(17)30558-5","article-title":"Putting polypills into practice: challenges and lessons learned","volume":"389","author":"Webster","year":"2017","journal-title":"Lancet"},{"key":"2025092012195569000_105.1.42.33","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000437738.63853.7a"},{"key":"2025092012195569000_105.1.42.34","unstructured":"Clinical Practice Guideline Secretariat. Clinical practice guidelines on primary and secondary prevention of cardiovascular disease 2017. Putrajaya, Malaysia: Ministry of Health, Malaysia, 2017."},{"key":"2025092012195569000_105.1.42.35","unstructured":"Centre for Chronic Disease Control, Public Health Foundation of India. Guideline for medical officers. Prevention and management of cardiovasular diseases, diabetes and stroke. Centre for Chronic Disease Control, Public Health Foundation of India. Guideline for medical officers New Delhi, 2009."},{"key":"2025092012195569000_105.1.42.36","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2014.11.176"},{"key":"2025092012195569000_105.1.42.37","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2016-309753"},{"key":"2025092012195569000_105.1.42.38","doi-asserted-by":"publisher","DOI":"10.1177\/2047487316638501"},{"key":"2025092012195569000_105.1.42.39","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1001\/jamainternmed.2016.9627","article-title":"Effect of reminder devices on medication adherence: The REMIND randomized clinical trial","volume":"177","author":"Choudhry","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2025092012195569000_105.1.42.40","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1001\/jamainternmed.2017.2449","article-title":"Effect of electronic reminders, financial incentives, and social support on outcomes after myocardial infarction: the heartstrong randomized clinical Trial","volume":"177","author":"Volpp","year":"2017","journal-title":"JAMA Intern Med"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/heartjnl-2018-313108","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T19:20:07Z","timestamp":1758396007000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/heartjnl-2018-313108"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,28]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,12,12]]},"published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.1136\/heartjnl-2018-313108"],"URL":"https:\/\/doi.org\/10.1136\/heartjnl-2018-313108","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"value":"1355-6037","type":"print"},{"value":"1468-201X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,28]]}}}