The Cardiovascular Polypill in the Prevention of Cardiovascular Disease

Abstract

The June 2003 edition of the British Medical Journal introduced Wald and Law’s concept of a polypill, also known as a fixed-dose combination (FDC) pill. Wald and Law proposed “a strategy to reduce cardiovascular disease by more than 80 %” by simultaneously addressing four cardiovascular risk factors regardless of pretreatment levels in a low-risk population. They stated, “the polypill strategy could largely prevent heart attacks and strokes if taken by everyone aged 55 and older, and everyone with existing cardiovascular disease,” and “widespread use would have a greater impact on the prevention of disease in the Western world than any other single intervention.” [1] Criticism of the polypill strategy is based on the view that the use of aspirin, statin, and blood pressure (BP)-lowering agents would largely be promoted in a primary prevention setting in a population at a low absolute risk of cardiovascular disease. It was argued that a large proportion of the population would be medicalized unnecessarily, inducing a sense of protection and deflecting attention from healthy behaviors. Although this strategy raised high hopes that a polypill-based treatment could reduce the incidence of atherosclerotic cardiovascular disease exceptionally, the bare truth is that cardiovascular disease is still the major cause of mortality and morbidity worldwide and the polypill has still not largely entered the market.