Polypill: the evidence and the promise

In spite of great scientific advances, cardiovascular disease is the commonest cause of death worldwide and current cardiovascular prevention strategies fail to achieve the full potential of risk modification. A large amount of evidence supports the use of pharmacological treatments both in primary and secondary prevention and it was hypothesized that a fixed-dose combination of such drugs, a 'polypill', may greatly simplify and improve current prevention strategies.

Several polypill formulations have been developed and a recent trial demonstrated the short-term feasibility, safety and efficacy (in reducing risk factor levels) of a polypill in individuals at moderate risk. Many challenges remain and studies are underway, which will address questions related to formulation of polypill(s), the long-term safety and tolerability, the efficacy in reducing risk factor levels and cardiovascular events, physician, patient and societal acceptability, adherence, regulatory requirements, cost and impact on lifestyle habits.

Theoretical models suggest that a polypill containing low-dose aspirin, three blood pressure-lowering drugs at half dose and a potent statin, administered to a large proportion of the population at risk for cardiovascular events, could reduce ischemic heart disease and strokes by over 80%. The feasibility of this approach has recently been shown in a clinical trial and ongoing studies will define whether the postulated benefits of the polypill will be observed.