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Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death and disability worldwide, yet ASCVD risk factor control and secondary prevention rates remain low. A fixed-dose combination of blood pressure- and cholesterol-lowering and antiplatelet treatments into a single pill, or polypill, has been proposed as one strategy to reduce the global burden of ASCVD.

Key findings

- The effects of fixed-dose combination therapy on all-cause mortality or atherosclerotic cardiovascular disease (ASCVD) events are uncertain. A limited number of trials reported these outcomes, and the included trials were primarily designed to observe changes in ASCVD risk factor levels rather than clinical events.

- Fixed-dose combination therapy is associated with modest increases in adverse events compared with placebo, active comparators, or usual care which may result from improved adherence to a multidrug regimen.

- There were reductions in ASCVC risk factors: systolic and diastolic blood pressure and total and LDL cholesterol. These risk factor changes would have been expected to result in a reduction in ASCVD events if sustained, but the trials reporting changes in risk factors were generally too short to detect a potential difference by their design.