Introduction

In his seminal work ‘Sick individuals, sick populations,’1 Geoffrey Rose postulated that reducing the population distribution of a causal risk factor would have a greater effect on population health than targeting only those at high risk (eg, as defined by a threshold value). Population interventions to reduce these risk factors (such as blood pressure) can encompass behavioural modification (eg, reducing dietary salt or smoking cessation) but, for maximum efficacy, should include evidence-based pharmacological treatments. As several established causal risk factors for cardiovascular disease (CVD) exist, each providing a separate target for pharmacological intervention, combining multiple drug treatments into a single pill (a so-called ‘polypill’) maximises efficacy (as originally suggested by Yusuf)2 and helps with drug concordance. This could potentially lead to the use of drugs prescribed to everyone (similar to a vaccine) resulting in potentially huge beneficial effects on population risk of disease.3 However, the concept of a polypill has received controversy, with concerns that it may lead to ‘medicalisation’ of otherwise healthy individuals.4–6 In this article, we set out a basis for why the polypill should be considered as a vital means to prevent vascular disease, and provide populations with the best potential for health, from which all individuals could individually benefit.