title: Polypill-based therapy likely to reduce ethnic inequities in use of cardiovascular preventive medications: Findings from a pragmatic randomised controlled trial.
abstract: The purpose of this study was to investigate the consistency of the proportional effect of fixed-dose combination therapy (the 'polypill') on the use of recommended cardiovascular preventative medications among indigenous Māori and non-indigenous adults in New Zealand.
  
  
  
  We randomised Māori and non-Māori primary care patients at high risk of cardiovascular disease (either because of a prior event or with an estimated 5-year risk of a first event of at least 15%) to a polypill (containing aspirin, statin and two antihypertensives) or usual care for a minimum of 12 months. All patients had indications for all polypill components according to their general practitioner, and all medications (including the polypill) were prescribed by the patient's general practitioner and dispensed at community pharmacies. The main outcome for this study was the use of all recommended medications (antiplatelet, statin and two antihypertensives) at 12 months. Heterogeneity in the effect of polypill-based care compared with usual care on this outcome by ethnicity was assessed by logistic regression.
  
  
  
  Baseline use of recommended medications was 36% (93/257) among Māori and 51% (130/156) among non-Māori participants. Polypill-based care was associated with an increase in the use of recommended medications among Māori (relative risk [RR]: 1.87; 95% confidence interval [CI]: 1.50-2.34) and non-Māori (RR: 1.66; 95% CI: 1.37-2.00) when compared with usual care at 12 months, and there was no statistically significant heterogeneity in this outcome by ethnicity (p = 0.92).
  
  
  
  Polypill-based care is likely to reduce absolute inequities between Māori and non-Māori in the use of recommended cardiovascular preventative medications given baseline absolute differences and the consistency of the proportional effect of this intervention by ethnicity in this pragmatic trial in primary care.
authors.affiliation: Department of Epidemiology and Biostatistics, University of Auckland, New Zealand v.selak@auckland.ac.nz.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Selak
authors.affiliation: Te Kupenga Hauora Māori, University of Auckland, New Zealand.
authors.forename: Matire
authors.initials: M
authors.lastname: Harwood
authors.affiliation: Department of General Practice and Primary Health Care, University of Auckland, New Zealand.
authors.forename: C
authors.initials: C
authors.lastname: Raina Elley
authors.affiliation: National Institute for Health Innovation, University of Auckland, New Zealand.
authors.forename: Chris
authors.initials: C
authors.lastname: Bullen
authors.affiliation: National Institute for Health Innovation, University of Auckland, New Zealand.
authors.forename: Angela
authors.initials: A
authors.lastname: Wadham
authors.affiliation: National Institute for Health Innovation, University of Auckland, New Zealand.
authors.forename: Varsha
authors.initials: V
authors.lastname: Parag
authors.affiliation: National Institute for Health Innovation, University of Auckland, New Zealand Royal College of Surgeons in Ireland, Ireland.
authors.forename: Natasha
authors.initials: N
authors.lastname: Rafter
authors.affiliation: Department of General Practice and Primary Health Care, University of Auckland, New Zealand.
authors.forename: Bruce
authors.initials: B
authors.lastname: Arroll
authors.affiliation: Waitemata District Health Board, New Zealand.
authors.forename: Dale
authors.initials: D
authors.lastname: Bramley
authors.affiliation: Invercargill Medical Centre, New Zealand.
authors.forename: Sue
authors.initials: S
authors.lastname: Crengle
mesh_terms: D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000517:prevention & control*; D004338:Drug Combinations; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009520:New Zealand / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D004338:Drug Combinations
keywords: Cardiovascular diseases; ethnic groups; healthcare disparities; polypill; secondary prevention