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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 …
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.