[The polypill for cardiovascular disease: why is it used so infrequently?]

Cardiovascular polypills or fixed-dose combination (FDC) therapy have been advocated to improve treatment and prevention of cardiovascular disease since 2003. Yet, it is still used infrequently in current practice. This is in contrast to the widespread use of fixed-dose drug combinations for HIV, tuberculosis, and malaria worldwide. Over the past 15 years, evidence from studies in patients with elevated cardiovascular risk or manifest cardiovascular disease has become available, showing that FDC therapy is a strategy which improves adherence, lowers risk factor levels better than usual care, improves adherence to treatment goals, considerably lowers daily intake of pills, and simplifies drug regimens. Furthermore, patients uniformly indicate that this type of therapy is preferred over prescription of individual pills. Also, FDC therapy is reimbursed. Yet, in the Netherlands, only a small percentage of patients is prescribed a fixed dose combination pill. This raises the question what the underlying barriers are to adoption in clinical practice: is it availability, willingness, awareness, or a combination of factors?