Polypill: the evidence and the promise

PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: 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.