Polypill and global cardiovascular health strategies

Despite encouraging advances in our knowledge of the prevention and treatment of atherothrombosis, cardiovascular (CV) disease remains the leading cause of death worldwide. The impressive growth of this epidemic during the last decade is due largely to the increasing incidence of CV diseases in low- and middle-income countries (LMICs). The uncontrolled rise in the incidence of risk factors (obesity, hypertension, tobacco, high cholesterol, diabetes) in these countries accounts largely for the increasing incidence of CV diseases. Lifestyle modification and pharmacologic treatment have been very effective in improving the risk profile in those individuals at high risk. In Western countries the impact of all these preventive and therapeutic interventions has been a substantial decline in CV mortality; however, the scenario is quite different in LMICs. Several problems limit the efficacy of secondary prevention strategies: inadequate health policies, poor availability, and lack of affordable medication in LMICs, as well as poor patient adherence to treatment. It has been suggested that along with the promotion of healthy lifestyles, a fixed-dose combination or polypill containing 2 or more drugs addressed to control different risk factors would improve accessibility to treatment, cost, and patient adherence to treatment. This review analyzes the potential role of the polypill strategy in primary and secondary CV prevention.