20 Aug “Polypill” for Cardiovascular Disease Prevention
Reviewed by K.M. Venkat Narayan, MD, MPH, FRCP, FACP
Wald NJ, Law MR: A strategy to reduce cardiovascular disease by more than 80%. BMJ 326:1419-1424, 2003
Objective. To assess the components of, and potential benefit and adverse effects of, a single daily pill (a theoretical “polypill”) to prevent cardiovascular disease (CVD) by simultaneously reducing four CVD risk factors (LDL cholesterol, blood pressure, platelet function, and serum homocysteine).
Design. Meta-analyses of published randomized trials and cohort studies.
End points. Proportional reduction in fatal and nonfatal ischemic heart disease (IHD) and stroke events, life years gained, and prevalence of adverse effects.
Results. A polypill composed of a statin; three pressure-lowering drugs, each at half of its standard dose; aspirin, 75 mg; and folic acid, 0.8 mg, was estimated to potentially reduce IHD events by 88% (95% CI 84-91%) and stroke by 80% (71-87%). One-third of those taking this polypill from age 55 years or from diagnosis of diabetes or CVD would potentially benefit, gaining on average about 11 years of life free from IHD event or stroke. Such a polypill would cause adverse symptoms in 8-15% of those taking it, depending on the specific components in the formulation.
Conclusion. The polypill strategy could prevent IHD and stroke if taken by CLINICAL DIABETES • Volume 22, Number 4, 2004 157 everyone (without contraindications) aged 55 years and older and everyone with existing CVD or diabetes regardless of their age. This potentially new and different strategy merits further consideration and careful evaluation.