Skip to main content
SpringerLink
Log in

Polypill: Lights and Shadows

  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

The idea of packaging and formulating several drugs commonly used in cardiovascular disease prevention into a single polypill is appealing. It is believed that the polypill would have several advantages over the separate use of several medications, enhancing acceptability and long-term adherence, with lower cost and easier accessibility. However, there are few data available on the efficacy and safety of polypill preparations for preventive purposes. The Indian Polycap Study (TIPS) was the first to systematically test the clinical application of the polypill; it included ramipril, hydrochlorothiazide, atenolol, aspirin, and simvastatin. Blood pressure and LDL levels were effectively lowered and antiplatelet function was demonstrated, but the effect of simvastatin was reduced because of an unexpected drug interaction. The polypill was well tolerated. Challenges to be resolved include the need to demonstrate conclusively the safety and efficacy of the polypill in large clinical end point trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Fox KA, Steg PG, Eagle KA, et al.: Decline in rates of death and heart failure in acute coronary syndromes, 1999–2006. JAMA 2007, 297:1892–1900.

    Article  CAS  PubMed  Google Scholar 

  2. Cannon CP: Can the polypill save the world from heart disease? Lancet 2009, 373:1313–1314.

    Article  PubMed  Google Scholar 

  3. Gaziano TA, Opie LH, Weinstein MC: Cardiovascular disease prevention with a multidrug regimen in the developing world: a cost-effectiveness analysis. Lancet 2006, 368:679–686.

    Article  CAS  PubMed  Google Scholar 

  4. Hippisley-Cox J, Coupland C: Effect of combinations of drugs on all cause mortality in patients with ischaemic heart disease: nested case-control analysis. BMJ 2005, 330:1059–1063.

    Article  CAS  PubMed  Google Scholar 

  5. Spence JD: Polypill: for Pollyanna. Int J Stroke 2008, 3:92–97.

    Article  PubMed  Google Scholar 

  6. • Lonn E, Yusuf S: Polypill: the evidence and the promise. Curr Opin Lipidol 2009, 20:453–459. This is a recent review on the polypill.

    Article  CAS  PubMed  Google Scholar 

  7. Yusuf S, Hawken S, Ounpuu S, et al.; INTERHEARY Study Investigators: Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART Study): case-control study. Lancet 2004, 364:937–952.

    Article  PubMed  Google Scholar 

  8. Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction and stroke in high risk patients. BMJ 2002, 324:71–86.

    Article  Google Scholar 

  9. Yusuf S, Peto R, Lewis J, et al.: Beta-blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985, 27:335–371.

    Article  CAS  PubMed  Google Scholar 

  10. Yusuf S, Sleight P, Pogue J, et al.: Effects of an angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000, 342:145–153.

    Article  CAS  PubMed  Google Scholar 

  11. Cholesterol Treatment Trialists’ (CTT) Collaborators: Efficacy and safety of cholesterol lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomized trials of statins. Lancet 2005, 366:1267–1278.

    Article  Google Scholar 

  12. Ford ES, Ajani UA, Croft JB, et al.: Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med 2007, 356:2388–2398.

    Article  CAS  PubMed  Google Scholar 

  13. World Health Statistics 2009. Table 2. Cause-specific mortality and morbidity. http://www.who.int/whosis/whostat/EN_WHS09_Table2.pdf. Accessed 5 August 2009.

  14. Yusuf S: Two decades of progress in preventing vascular disease. Lancet 2002, 360:2–3.

    Article  PubMed  Google Scholar 

  15. Wald NJ, Law MR: A strategy to reduce cardiovascular disease by more than 80%. BMJ 2003, 326:1419–1424.

    Article  CAS  PubMed  Google Scholar 

  16. Law MR, Wald NJ, Rudnicka AR: Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ 2003, 326:1423–1429.

    Article  CAS  PubMed  Google Scholar 

  17. Law MR, Wald NJ, Morris JK, et al.: Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ 2003, 326:1427–1434.

    Article  CAS  PubMed  Google Scholar 

  18. Wald DS, Law M, Morris JK: Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis. BMJ 2002, 325:1202–1208.

    Article  PubMed  Google Scholar 

  19. Lonn E, Yusuf S, Arnold MJ, et al.; Heart Outcomes Prevention Evaluation (HOPE) 2 Investigators: Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med 2006, 354:1567–1577.

    Article  CAS  PubMed  Google Scholar 

  20. Hackam DG, Leiter LA, Yan AT, et al.: Missed opportunities for the secondary prevention of cardiovascular disease in Canada. Can J Cardiol 2007, 23:1124–1130.

    PubMed  Google Scholar 

  21. Ko DT, Krumholz HM, Wang Y, et al.: Regional differences in process of care and outcomes for older acute myocardial infarction patients in the United States and Ontario, Canada. Circulation 2007, 115:196–203.

    Article  PubMed  Google Scholar 

  22. Kotseva K, Wood D, De Backer G, et al.: Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet 2009, 373:929–940.

    Article  PubMed  Google Scholar 

  23. Goodman SG, Huang W, Yan AT, et al.: The expanded Global Registry of Acute Coronary Events: baseline characteristics, management practices, and hospital outcomes of patients with acute coronary syndromes. Am Heart J 2009, 158:193–201.

    Article  PubMed  Google Scholar 

  24. Mendis S, Abegunde D, Yusuf S, et al.: WHO study on Prevention of REcurrences of Myocardial Infarction and StrokE (WHO-PREMISE). Bull World Health Organ 2005, 83:820–829.

    PubMed  Google Scholar 

  25. Mendis S, Fukino K, Cameron A, et al.: The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries. Bull World Health Organ 2007, 85:279–288.

    Article  PubMed  Google Scholar 

  26. Jackevicius CA, Mamdani M, Tu JV: Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 2002, 288:462–467.

    Article  PubMed  Google Scholar 

  27. Benner JS, Glynn RJ, Mogun H, et al.: Long-term persistence in use of statin therapy in elderly patients. JAMA 2002, 288:455–461.

    Article  PubMed  Google Scholar 

  28. Fonarow GC, French WJ, Frederick PD: Trends in the use of lipid-lowering medications at discharge in patients with acute myocardial infarction: 1998 to 2006. Am Heart J 2009, 157:185–194.

    Article  PubMed  Google Scholar 

  29. Oliveira GB, Avezum A, Anderson FA Jr, et al.: Use of proven therapies in non-ST-elevation acute coronary syndromes according to evidence-based risk stratification. Am Heart J 2007, 153:493–499.

    Article  CAS  PubMed  Google Scholar 

  30. Simpson SH, Eurich DT, Majumdar SR, et al.: A meta-analysis of the association between adherence to drug therapy and mortality. BMJ 2006, 333:15–20.

    Article  PubMed  Google Scholar 

  31. Jackevicius CA, Li P, Tu JV: Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction. Circulation 2008, 117:1028–1036.

    Article  PubMed  Google Scholar 

  32. •• Indian Polycap Study (TIPS), Yusuf S, Pais P, et al.: Effects of a polypill (Polycap) on risk factors in middle-aged individuals without cardiovascular disease (TIPS): a phase II, double-blind, randomised trial. Lancet 2009, 373:1341–1351. This was the first clinical trial establishing the clinical application of the polypill.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

Dr. Teo has been a member of the Advisory Board of Boehringer Ingelheim and has received grants and honoraria from that company. No othe rpotential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. McMaster University Medical Centre, Rm 3U4, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada

    Koon K. Teo & Yan Liang

Authors
  1. Koon K. Teo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yan Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Koon K. Teo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Teo, K.K., Liang, Y. Polypill: Lights and Shadows. Curr Hypertens Rep 12, 276–281 (2010). https://doi.org/10.1007/s11906-010-0127-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-010-0127-1

Keywords

Search

Navigation