The polypill in the primary prevention of cardiovascular disease

Coronary heart disease (CHD) and stroke are the most common causes of death worldwide. The polypill, a multi-component tablet or capsule designed to reduce several cardiovascular causal risk factors simultaneously, has the potential to reduce the incidence of heart attacks and stroke by about 80%, the precise reduction depending on the formulation of the polypill and adherence to preventive treatment. The full public health impact can only be realized if the polypill is used to prevent first cardiovascular disease events, because most heart attacks and strokes are first events. A simple and effective method of selecting who should be offered the polypill is needed. Even though serum cholesterol and blood pressure are important causes of CHD and stroke and lowering them has a large preventive effect (a 1.8 mmol/L reduction in LDL cholesterol reduces the incidence of CHD events by about 60% and a 10 mmHg reduction in diastolic blood pressure also reduces the incidence of stroke by about 60%), they are poor screening tests. They add little to age in discriminating between individuals who will and will not have a CHD event or stroke. Including them in a risk assessment algorithm needlessly complicates the screening process and tends to medicalize the preventive strategy. Age alone is effective and a simpler means of selecting people for preventive treatment using the polypill.