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Polypill is not a ‘vaccine-like’ solution for primary cardiovascular disease prevention in all parts of the world
  1. Željko Reiner
  1. Correspondence to Professor Željko Reiner, University Hospital Centre Zagreb, School of Medicine, Zagreb University, Croatia; zreiner{at}

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In their commentary, Holmes and Bhalla1 discussed the polypill reframing it as a sort of ‘vaccine’ for cardiovascular disease (CVD) primary prevention.

The idea of polypill is more than a decade old. In 2003, Wald and Law claimed that ischaemic heart disease could be reduced by 88% and strokes by 80% if all those over 55 years of age were given a polypill, a fixed-dose combination containing three low-dose blood pressure (BP) lowering medications (a β-blocker, an antidiuretic and an ACE inhibitor), a statin, low-dose aspirin and folic acid, without monitoring risk factor levels or biochemical safety parameters.2 They suggested that such a polypill would reduce diastolic BP by 11 mm Hg and low-density lipoprotein (LDL)-cholesterol by 70 mg/dL. However, their estimated reduction in LDL-cholesterol used a baseline of 4.8 mmol/L, which is very high according to the recent guidelines.3 ,4 This already indicates one of the possible problems with polypill concept. A clinical trial in patients at low cardiovascular risk found …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.