Polypill protects MAFLD patients from cardiovascular events and mortality: a prospective trial

• Published in: Hepatology international 2023-08, Vol.17 (4), p.882-888
• Main Authors: Ramandi, Alireza, George, Jacob, Merat, Shahin, Jafari, Elham, Sharafkhah, Maryam, Radmard, Amir Reza, Nateghi Baygi, Alireza, Delavari, Alireza, Mohammadi, Zahra, Poustchi, Hossein, Malekzadeh, Reza
• Format: Article
• Language: English
• Subjects: Aspirin; Aspirin - therapeutic use; Atorvastatin; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Colorectal Surgery; Drug Combinations; Fatty liver; Hepatology; Humans; Hydrochlorothiazide; Liver; Liver diseases; Medicine; Medicine & Public Health; Mortality; Non-alcoholic Fatty Liver Disease - complications; Original Article; Prospective Studies; Surgery
• ISSN: 1936-0533; 1936-0541
• DOI: 10.1007/s12072-023-10542-9

Background Metabolic dysfunction-associated fatty liver disease (MAFLD) is a novel term that distinguishes patients at risk of adverse clinical outcomes with higher accuracy than those with non-alcoholic fatty liver disease (NAFLD). Cardiovascular mortality is the leading cause of death in MAFLD. The current literature lacks large-scale prospective studies that address preventive approaches for cardiovascular health in MAFLD. We investigated whether MAFLD patients benefit from a fixed-dose combination therapy (Aspirin, hydrochlorothiazide, atorvastatin, valsartan), known as a Polypill. Methods Analysis was performed (stratified based on MAFLD status) of a clinical trial that included 1596 individuals randomly allocated to an intervention (polypill) or a control (usual care) group. Patients were followed up for five years for any adverse drug reaction, major cardiovascular events, and mortality. Univariable and multivariable survival analyses were performed, and the interaction level was assessed by R programming. Results Patients who consumed the polypill had significantly lower hazard ratios of major cardiovascular events incidence (HR 0.56, 95% CI 0.41–0.78) and cardiovascular mortality (HR 0.41, 95% CI 0.2–0.86) compared to the control group. Polypill showed significantly better results in lowering cardiovascular events in MAFLD patients than in the general population. ( p -value for interaction: 0.028). Moreover, comparing those patients who had high adherence to the Polypill, with the control group, further enhanced the results. Conclusions Major cardiovascular events are prevented in MAFLD patients who consume the Polypill. MAFLD patients benefit from the Polypill more than the general population.