BMJ  2003;326:1419 (28 June), doi:10.1136/bmj.326.7404.1419

Paper

A strategy to reduce cardiovascular disease by more than 80%

¹ Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and the London, Queen Mary's School of Medicine and Dentistry, University of London, London EC1M 6BQ

Objectives To determine the combination of drugs and vitamins, and their doses, for use in a single daily pill to achieve a large effect in preventing cardiovascular disease with minimal adverse effects. The strategy was to simultaneously reduce four cardiovascular risk factors (low density lipoprotein cholesterol, blood pressure, serum homocysteine, and platelet function) regardless of pretreatment levels.

Design We quantified the efficacy and adverse effects of the proposed formulation from published meta-analyses of randomised trials and cohort studies and a meta-analysis of 15 trials of low dose (50-125 mg/day) aspirin.

Outcome measures Proportional reduction in ischaemic heart disease (IHD) events and strokes; life years gained; and prevalence of adverse effects.

Results The formulation which met our objectives was: a statin (for example, atorvastatin (daily dose 10 mg) or simvastatin (40 mg)); three blood pressure lowering drugs (for example, a thiazide, a blocker, and an angiotensin converting enzyme inhibitor), each at half standard dose; folic acid (0.8 mg); and aspirin (75 mg). We estimate that the combination (which we call the Polypill) reduces IHD events by 88% (95% confidence interval 84% to 91%) and stroke by 80% (71% to 87%). One third of people taking this pill from age 55 would benefit, gaining on average about 11 years of life free from an IHD event or stroke. Summing the adverse effects of the components observed in randomised trials shows that the Polypill would cause symptoms in 8-15% of people (depending on the precise formulation).

Conclusion The Polypill strategy could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing cardiovascular disease. It would be acceptably safe and with widespread use would have a greater impact on the prevention of disease in the Western world than any other single intervention.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Joshi, R., Jan, S., Wu, Y., MacMahon, S. (2009). Reply.. J Am Coll Cardiol 54: 91-92 [Full text]  
• Moons, K. G M, Altman, D. G, Vergouwe, Y., Royston, P. (2009). Prognosis and prognostic research: application and impact of prognostic models in clinical practice. BMJ 338: b606-b606 [Full text]  
• Elijovich, F., Laffer, C. (2009). A role for single-pill triple therapy in hypertension. Ther Adv Cardiovasc Dis 3: 231-240 [Abstract]  
• Aronson, J. K. (2009). From prescription-only to over-the-counter medicines ('PoM to P'): time for an intermediate category. Br Med Bull 90: 63-69 [Abstract] [Full text]  
• McManus, R. J, Mant, J. (2009). Management of blood pressure in primary care. BMJ 338: b940-b940 [Full text]  
• Patel, A. (2009). Cardiovascular risk: who should we treat, and how much should we stratify?. Heart 95: 783-784 [Full text]  
• Raine, R., Wong, W., Ambler, G., Hardoon, S., Petersen, I., Morris, R., Bartley, M., Blane, D. (2009). Sociodemographic variations in the contribution of secondary drug prevention to stroke survival at middle and older ages: cohort study. BMJ 338: b1279-b1279 [Abstract] [Full text]  
• Joshi, R., Chow, C. K., Raju, P. K., Raju, R., Reddy, K. S., MacMahon, S., Lopez, A. D., Neal, B. (2009). Fatal and Nonfatal Cardiovascular Disease and the Use of Therapies for Secondary Prevention in a Rural Region of India. Circulation 119: 1950-1955 [Abstract] [Full text]  
• Nurmohamed, M. T, Dijkmans, B. A C (2009). Dyslipidaemia, statins and rheumatoid arthritis. Ann Rheum Dis 68: 453-455 [Full text]  
• Garber, A. M. (2009). An Uncertain Future for Cardiovascular Drug Development?. NEJM 360: 1169-1171 [Full text]  
• Joubert, J, Reid, C, Barton, D, Cumming, T, McLean, A, Joubert, L, Barlow, J, Ames, D, Davis, S (2009). Integrated care improves risk-factor modification after stroke: initial results of the Integrated Care for the Reduction of Secondary Stroke model. J. Neurol. Neurosurg. Psychiatry 80: 279-284 [Abstract] [Full text]  
• Koh, K. K., Oh, P. C., Quon, M. J. (2009). Does reversal of oxidative stress and inflammation provide vascular protection?. Cardiovasc Res 81: 649-659 [Abstract] [Full text]  
• Farmer, A. (2008). Taking tablets for chronic illness: where next?. Chronic Illness 4: 235-238  
• Bulugahapitiya, U, Siyambalapitiya, S, Sithole, J, Fernando, D J, Idris, I (2008). Age threshold for vascular prophylaxis by aspirin in patients without diabetes. Heart 94: 1429-1432 [Abstract] [Full text]  
• Bhattacharyya, O. K. MD PhD, Shah, B. R. MD PhD, Booth, G. L. MD MSc (2008). Management of cardiovascular disease in patients with diabetes: the 2008 Canadian Diabetes Association guidelines. CMAJ 179: 920-926 [Full text]  
• Marshall, T., on behalf of Fatemeh Malekzadeh, Akram Pourshams,, (2008). News of the polypill. BMJ 337: a2160-a2160 [Full text]  
• Rodgers, A., Patel, A. (2008). Why is there more heat than light concerning the polypill?. BMJ 337: a2162-a2162 [Full text]  
• Watts, G. (2008). What happened to the polypill?. BMJ 337: a1822-a1822 [Full text]  
• Jackson, R., Wells, S., Rodgers, A. (2008). Will screening individuals at high risk of cardiovascular events deliver large benefits? Yes. BMJ 337: a1371-a1371 [Full text]  
• Egan, B. M., Nesbitt, S. D., Julius, S. (2008). Review: Prehypertension: should we be treating with pharmacologic therapy?. Ther Adv Cardiovasc Dis 2: 305-314 [Abstract]  
• Lonn, E. (2008). Homocysteine-Lowering B Vitamin Therapy in Cardiovascular Prevention--Wrong Again?. JAMA 299: 2086-2087 [Full text]  
• Dubel, G. J, Murphy, T. P (2008). The role of percutaneous revascularization for renal artery stenosis. Vasc Med 13: 141-156 [Abstract]  
• Rizza, R., Eddy, D., Kahn, R. (2008). Cure, Care, and Commitment: What Can We Look Forward To?. Diabetes Care 31: 1051-1059 [Full text]  
• Sabroe, I, Parker, L C, Calverley, P M A, Dower, S K, Whyte, M K B (2008). Pathological networking: a new approach to understanding COPD. Postgrad. Med. J. 84: 259-264 [Abstract] [Full text]  
• Ebrahim, S. (2008). Chronic diseases and calls to action. Int J Epidemiol 37: 225-230 [Full text]  
• Choudhry, N. K., Patrick, A. R., Antman, E. M., Avorn, J., Shrank, W. H. (2008). Cost-Effectiveness of Providing Full Drug Coverage to Increase Medication Adherence in Post-Myocardial Infarction Medicare Beneficiaries. Circulation 117: 1261-1268 [Abstract] [Full text]  
• Bakris, G. L., Berkwits, M. (2008). Trials That Matter: The Effect of a Fixed-Dose Combination of an Angiotensin-Converting Enzyme Inhibitor and a Diuretic on the Complications of Type 2 Diabetes. ANN INTERN MED 148: 400-401 [Full text]  
• Badger, S. A., Soong, C. V., Lee, B., Swain, G. R., McGuigan, K. E. (2008). Prescribing Practice of General Practitioners in Northern Ireland for Peripheral Arterial Disease. ANGIOLOGY 59: 57-63 [Abstract]  
• Wienbergen, H., Senges, J., Gitt, A. K. (2008). Should We Prescribe Statin and Aspirin for Every Diabetic Patient?: Is it time for a polypill?. Diabetes Care 31: S222-S225 [Full text]  
• Stirban, A. O., Tschoepe, D. (2008). Should We Be More Aggressive in the Therapy Against Cardiovascular Risk Factors?: Should we prescribe statin and aspirin for every diabetic patient, or is it time for a polypill?. Diabetes Care 31: S226-S228 [Abstract] [Full text]  
• Grundy, S. M. (2008). Promise of Low-Density Lipoprotein-Lowering Therapy for Primary and Secondary Prevention. Circulation 117: 569-573 [Full text]  
• Capewell, S, O'Flaherty, M (2008). Maximising secondary prevention therapies in patients with coronary heart disease. Heart 94: 8-9 [Full text]  
• DeWilde, S, Carey, I M, Richards, N, Whincup, P H, Cook, D G (2008). Trends in secondary prevention of ischaemic heart disease in the UK 1994 2005: use of individual and combination treatment. Heart 94: 83-88 [Abstract] [Full text]  
• Karthikeyan, G., Xavier, D., Prabhakaran, D., Pais, P. (2007). Perspectives on the management of coronary artery disease in India. Heart 93: 1334-1338 [Abstract] [Full text]  
• Loscalzo, J. (2007). Association Studies in an Era of Too Much Information: Clinical Analysis of New Biomarker and Genetic Data. Circulation 116: 1866-1870 [Full text]  
• Huang, E. S., Brown, S. E.S., Ewigman, B. G., Foley, E. C., Meltzer, D. O. (2007). Patient Perceptions of Quality of Life With Diabetes-Related Complications and Treatments. Diabetes Care 30: 2478-2483 [Abstract] [Full text]  
• van der Elst, M. E, Bouvy, M. L, de Blaey, C. J, de Boer, A. (2007). Effect of drug combinations on admission for recurrent myocardial infarction. Heart 93: 1226-1230 [Abstract] [Full text]  
• Wald, D. S, Morton, G., Walker, K., Iosson, N., Curzen, N. P (2007). Long-Term Continuation on Cardiovascular Drug Treatment in Patients with Coronary Heart Disease. The Annals of Pharmacotherapy 41: 1644-1647 [Abstract] [Full text]  
• Chow, C K, Pell, A C H, Walker, A, O'Dowd, C, Dominiczak, A F, Pell, J P (2007). Families of patients with premature coronary heart disease: an obvious but neglected target for primary prevention. BMJ 335: 481-485 [Full text]  
• Sabroe, I., Parker, L. C, Calverley, P. M A, Dower, S. K, Whyte, M. K B (2007). Pathological networking: a new approach to understanding COPD. Thorax 62: 733-738 [Abstract] [Full text]  
• Bonneux, L. (2007). Cardiovascular risk models. BMJ 335: 107-108 [Full text]  
• Matfin, G. (2007). Aspects of drug development and clinical trials -- Part 2. British Journal of Diabetes & Vascular Disease 7: 149-150  
• Matfin, G. (2007). Review: Challenges in developing therapies for the metabolic syndrome. British Journal of Diabetes & Vascular Disease 7: 152-156 [Abstract]  
• Authors/Task Force Members:, , Mancia, G., De Backer, G., Dominiczak, A., Cifkova, R., Fagard, R., Germano, G., Grassi, G., Heagerty, A. M., Kjeldsen, S. E., Laurent, S., Narkiewicz, K., Ruilope, L., Rynkiewicz, A., Schmieder, R. E., Struijker Boudier, H. A.J., Zanchetti, A., ESC Committee for Practice Guidelines (CPG):, , Vahanian, A., Camm, J., De Caterina, R., Dean, V., Dickstein, K., Filippatos, G., Funck-Brentano, C., Hellemans, I., Kristensen, S. D., McGregor, K., Sechtem, U., Silber, S., Tendera, M., Widimsky, P., Zamorano, J. L., ESH Scientific Council:, , Kjeldsen, S. E., Erdine, S., Narkiewicz, K., Kiowski, W., Agabiti-Rosei, E., Ambrosioni, E., Cifkova, R., Dominiczak, A., Fagard, R., Heagerty, A. M., Laurent, S., Lindholm, L. H., Mancia, G., Manolis, A., Nilsson, P. M., Redon, J., Schmieder, R. E., Struijker-Boudier, H. A.J., Viigimaa, M., Document Reviewers:, , Filippatos, G., Adamopoulos, S., Agabiti-Rosei, E., Ambrosioni, E., Bertomeu, V., Clement, D., Erdine, S., Farsang, C., Gaita, D., Kiowski, W., Lip, G., Mallion, J.-M., Manolis, A. J., Nilsson, P. M., O'Brien, E., Ponikowski, P., Redon, J., Ruschitzka, F., Tamargo, J., van Zwieten, P., Viigimaa, M., Waeber, B., Williams, B., Zamorano, J. L. (2007). 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 0: ehm236v1-75 [Full text]  
• Schiff, E., Gurgevich, S., Caspi, O. (2007). Potential Synergism between Hypnosis and Acupuncture--Is the Whole More Than the Sum of Its Parts?. Evid Based Complement Alternat Med 4: 233-240 [Abstract] [Full text]  
• Hackam, D. G., Spence, J. D. (2007). Combining Multiple Approaches for the Secondary Prevention of Vascular Events After Stroke: A Quantitative Modeling Study. Stroke 38: 1881-1885 [Abstract] [Full text]  
• James, P. D, Wilkins, R., Detsky, A. S, Tugwell, P., Manuel, D. G (2007). Avoidable mortality by neighbourhood income in Canada: 25 years after the establishment of universal health insurance. J. Epidemiol. Community Health 61: 287-296 [Abstract] [Full text]  
• Reid, J. L. (2007). Fall and Rise of Polypharmacy?. Hypertension 49: 266-267 [Full text]  
• Reddy, K. S. (2007). The Preventive Polypill -- Much Promise, Insufficient Evidence. NEJM 356: 212-212 [Full text]  
• Gaziano, T. A. (2007). Reducing The Growing Burden Of Cardiovascular Disease In The Developing World. Health Aff (Millwood) 26: 13-24 [Abstract] [Full text]  
• Mensah, G. A., Brown, D. W. (2007). An Overview Of Cardiovascular Disease Burden In The United States. Health Aff (Millwood) 26: 38-48 [Abstract] [Full text]  
• Pearson, T. A. (2007). The Prevention Of Cardiovascular Disease: Have We Really Made Progress?. Health Aff (Millwood) 26: 49-60 [Abstract] [Full text]  
• Choudhry, N. K., Avorn, J., Antman, E. M., Schneeweiss, S., Shrank, W. H. (2007). Should Patients Receive Secondary Prevention Medications For Free After A Myocardial Infarction? An Economic Analysis. Health Aff (Millwood) 26: 186-194 [Abstract] [Full text]  
• Marshall, T, Bryan, S, Gill, P, Greenfield, S, Gutridge, K, Birmingham Patient Preferences Group, (2006). Predictors of patients' preferences for treatments to prevent heart disease. Heart 92: 1651-1655 [Abstract] [Full text]  
• Franco, O. H, Steyerberg, E. W, Peeters, A., Bonneux, L. (2006). Effectiveness calculation in economic analysis: the case of statins for cardiovascular disease prevention.. J. Epidemiol. Community Health 60: 839-845 [Abstract] [Full text]  
• O'Connor, P. J. (2006). Improving medication adherence: challenges for physicians, payers, and policy makers.. Arch Intern Med 166: 1802-1804 [Full text]  
• O'Kennedy, N., Crosbie, L., Whelan, S., Luther, V., Horgan, G., Broom, J. I, Webb, D. J, Duttaroy, A. K (2006). Effects of tomato extract on platelet function: a double-blinded crossover study in healthy humans.. Am. J. Clin. Nutr. 84: 561-569 [Abstract] [Full text]  
• Hammerman-Rozenberg, R., Jacobs, J. M., Azoulay, D., Stessman, J. (2006). Aspirin prophylaxis and the prevalence of anaemia. Age Ageing 35: 514-517 [Abstract] [Full text]  
• Bucci, K. K., Possidente, C. J. (2006). Combination-drug products: Benefit or burden to patients?. Am J Health Syst Pharm 63: 1654-1655 [Full text]  
• Colagiuri, R., Colagiuri, S., Yach, D., Pramming, S. (2006). The Answer to Diabetes Prevention: Science, Surgery, Service Delivery, or Social Policy?. Am. J. Public Health 96: 1562-1569 [Abstract] [Full text]  
• Asia Pacific Cohort Studies Collaboration, (2006). The impact of cardiovascular risk factors on the age-related excess risk of coronary heart disease. Int J Epidemiol 35: 1025-1033 [Abstract] [Full text]  
• Sleight, P., Pouleur, H., Zannad, F. (2006). Benefits, challenges, and registerability of the polypill. Eur Heart J 27: 1651-1656 [Abstract] [Full text]  
• Yusuf, S. (2006). Preventing Vascular Events Due to Elevated Blood Pressure. Circulation 113: 2166-2168 [Full text]  
• Sambu, N, Wald, D S, Seddon, M, Simpson, I A (2006). Undertreatment of coronary heart disease in patients undergoing coronary artery bypass surgery.. Heart 92: 697-698 [Full text]  
• Falk, E. (2006). Pathogenesis of atherosclerosis.. J Am Coll Cardiol 47: C7-C12 [Abstract] [Full text]  
• Bonaa, K. H., Njolstad, I., Ueland, P. M., Schirmer, H., Tverdal, A., Steigen, T., Wang, H., Nordrehaug, J. E., Arnesen, E., Rasmussen, K., the NORVIT Trial Investigators, (2006). Homocysteine Lowering and Cardiovascular Events after Acute Myocardial Infarction. NEJM 354: 1578-1588 [Abstract] [Full text]  
• Jackson, R., Lynch, J., Harper, S. (2006). Preventing coronary heart disease.. BMJ 332: 617-618 [Full text]  
• Manuel, D. G, Lim, J., Tanuseputro, P., Anderson, G. M, Alter, D. A, Laupacis, A., Mustard, C. A (2006). Revisiting Rose: strategies for reducing coronary heart disease.. BMJ 332: 659-662 [Full text]  
• Franco, O. H, Steyerberg, E. W, de Laet, C. (2006). The polypill: at what price would it become cost effective?. J. Epidemiol. Community Health 60: 213-217 [Abstract] [Full text]  
• Ramsay, S. E, Whincup, P. H, Lawlor, D. A, Papacosta, O., Lennon, L. T, Thomas, M. C, Ebrahim, S., Morris, R. W (2006). Secondary prevention of coronary heart disease in older patients after the national service framework: population based study. BMJ 332: 144-145 [Abstract] [Full text]  
• Marks, J. B. (2006). Metabolic Syndrome: To Be or Not To Be?. Clin. Diabetes 24: 3-4 [Full text]  
• Kaplan, N. M. (2006). Treatment of Hypertension: Remaining Issues After the Anglo-Scandinavian Cardiac Outcomes Trial. Hypertension 47: 10-13 [Full text]  
• Koh, K. K., Han, S. H., Quon, M. J. (2005). Inflammatory Markers and the Metabolic Syndrome: Insights From Therapeutic Interventions. J Am Coll Cardiol 46: 1978-1985 [Abstract] [Full text]  
• Choi, B. C K, Hunter, D. J, Tsou, W., Sainsbury, P. (2005). Diseases of comfort: primary cause of death in the 22nd century. J. Epidemiol. Community Health 59: 1030-1034 [Abstract] [Full text]  
• Lewington, S., Clarke, R. (2005). Combined Effects of Systolic Blood Pressure and Total Cholesterol on Cardiovascular Disease Risk. Circulation 112: 3373-3374 [Full text]  
• Asia Pacific Cohort Studies Collaboration, (2005). Joint Effects of Systolic Blood Pressure and Serum Cholesterol on Cardiovascular Disease in the Asia Pacific Region. Circulation 112: 3384-3390 [Abstract] [Full text]  
• Lewis, S. J, Ebrahim, S., Davey Smith, G. (2005). Meta-analysis of MTHFR 677C->T polymorphism and coronary heart disease: does totality of evidence support causal role for homocysteine and preventive potential of folate?. BMJ 331: 1053- [Abstract] [Full text]  
• Sud, A., Kline-Rogers, E. M, Eagle, K. A, Fang, J., Armstrong, D. F, Rangarajan, K., Otten, R. F, Stafkey-Mailey, D. R, Taylor, S. D, Erickson, S. R (2005). Adherence to Medications by Patients After Acute Coronary Syndromes. The Annals of Pharmacotherapy 39: 1792-1797 [Abstract] [Full text]  
• Combination Pharmacotherapy and Public Health Rese, (2005). Combination Pharmacotherapy for Cardiovascular Disease. ANN INTERN MED 143: 593-599 [Abstract] [Full text]  
• Fosslien, E. (2005). Cardiovascular Complications of Non-Steroidal Anti-Inflammatory Drugs. Annals of Clinical & Laboratory Science 35: 347-385 [Abstract] [Full text]  
• Ebrahim, S., Smeeth, L. (2005). Non-communicable diseases in low and middle-income countries: a priority or a distraction?. Int J Epidemiol 34: 961-966 [Full text]  
• Paraskevas, K. I., Daskalopoulou, S. S., Daskalopoulos, M. E., Liapis, C. D. (2005). Secondary Prevention of Ischemic Cerebrovascular Disease. What Is the Evidence?. ANGIOLOGY 56: 539-552 [Abstract]  
• Emberson, J. R., Whincup, P. H., Morris, R. W., Wannamethee, S. G., Shaper, A. G. (2005). Lifestyle and cardiovascular disease in middle-aged British men: the effect of adjusting for within-person variation. Eur Heart J 26: 1774-1782 [Abstract] [Full text]  
• Norris, J. W. (2005). Antiplatelet Agents in Secondary Prevention of Stroke: A Perspective. Stroke 36: 2034-2036 [Abstract] [Full text]  
• Williams, M. T., Hord, N. G. (2005). The Role of Dietary Factors in Cancer Prevention: Beyond Fruits and Vegetables. Nutr Clin Pract 20: 451-459 [Abstract] [Full text]  
• Gorelick, P. B., Weisman, S. M. (2005). Risk of Hemorrhagic Stroke With Aspirin Use: An Update. Stroke 36: 1801-1807 [Abstract] [Full text]  
• Hanson, M, Gluckman, P (2005). Endothelial dysfunction and cardiovascular disease: the role of predictive adaptive responses. Heart 91: 864-866 [Full text]  
• The National Heart, Lung, and Blood Institute Work, (2005). Major Clinical Trials of Hypertension: What Should Be Done Next?. Hypertension 46: 1-6 [Abstract] [Full text]  
• Elwood, P., Morgan, G., Brown, G., Pickering, J. (2005). Aspirin for everyone older than 50?: FOR. BMJ 330: 1440-1441 [Full text]  
• Choudhry, N. K., Avorn, J. (2005). Over-the-Counter Statins. ANN INTERN MED 142: 910-913 [Abstract] [Full text]  
• Lee, T. H (2005). Review: angiotension receptor blockers do not differ from ACE inhibitors in chronic heart failure or acute MI. Evid. Based Med. 10: 76-76 [Full text]  
• Chapman, R. H., Benner, J. S., Petrilla, A. A., Tierce, J. C., Collins, S. R., Battleman, D. S., Schwartz, J. S. (2005). Predictors of Adherence With Antihypertensive and Lipid-Lowering Therapy. Arch Intern Med 165: 1147-1152 [Abstract] [Full text]  

Rapid Responses:

Read all Rapid Responses

Costing the polypill, £60 per year.

john s ashcroft
bmj.com, 27 Jun 2003 [Full text]

More Compelling Evidence

William E. Osmun
bmj.com, 27 Jun 2003 [Full text]

Beware the Epidemiology

Bruce Bain
bmj.com, 27 Jun 2003 [Full text]

Good news: All we need to do now is get people to prescribe it and then take it...

Alexander M Clark
bmj.com, 27 Jun 2003 [Full text]

correction to cost of prescribing polypill

john s ashcroft
bmj.com, 27 Jun 2003 [Full text]

Now who's playing God …

Steve Taylor, et al.
bmj.com, 27 Jun 2003 [Full text]

Pilly Polly Doo Dah all the way

Malcolm Kendrick
bmj.com, 27 Jun 2003 [Full text]

PolyPill may not decrease all-cause mortality

Eddie Vos
bmj.com, 27 Jun 2003 [Full text]

Only 80% reduction? Why not go for 100%?

Barry A Groves
bmj.com, 27 Jun 2003 [Full text]

Whose Life Is It Anyway? The Polypill May Increase Health Inequalities

Michael A Soljak
bmj.com, 27 Jun 2003 [Full text]

Shabby Medical Thinking

Nicholas M Regush
bmj.com, 27 Jun 2003 [Full text]

A gauntlet thrown at drug companies or doctors?

Richard G Fiddian-Green
bmj.com, 28 Jun 2003 [Full text]

The 'Vacca Foeda' PolyPill

Joseph .C. Obi
bmj.com, 28 Jun 2003 [Full text]

Impact of single normal dose blood pressure medications

Bala Subramanian
bmj.com, 28 Jun 2003 [Full text]

Polypill drawbacks and multivitamin as alternative

BIll Sardi
bmj.com, 28 Jun 2003 [Full text]

The Big Issue

Dan Rutherford
bmj.com, 28 Jun 2003 [Full text]

new paradigm

Martin R Innes
bmj.com, 28 Jun 2003 [Full text]

Dumbfounded

Peter J Hosein
bmj.com, 28 Jun 2003 [Full text]

Also dumbfounded

Margaret J Tyson
bmj.com, 29 Jun 2003 [Full text]

Can anyone afford to live a very long life?

Mark Hochhauser, Ph.D.
bmj.com, 29 Jun 2003 [Full text]

A Sad Day For British Medicine

Allan Withnell
bmj.com, 29 Jun 2003 [Full text]

Treat people not populations

Eugene A. Rybinski
bmj.com, 29 Jun 2003 [Full text]

polypill ; for all races, sexes and seasons ?

Adesuyi Ajayi, et al.
bmj.com, 29 Jun 2003 [Full text]

Old joke and current practice

Adrian K Midgley
bmj.com, 29 Jun 2003 [Full text]

What do we die then?

Roger Wanner
bmj.com, 29 Jun 2003 [Full text]

POLYPILL, AN IDEA, PERHAPS A VERY GOOD ONE, BUT NOT A JOKE

CELIO LEVYMAN,MD,MSc, et al.
bmj.com, 30 Jun 2003 [Full text]

WHEN?

Linda L Gimnich
bmj.com, 30 Jun 2003 [Full text]

About as believable as the tooth fairy

Adam Jacobs
bmj.com, 30 Jun 2003 [Full text]

A pill a day keeps health away?

Ewan Hamnett
bmj.com, 30 Jun 2003 [Full text]

Shame on you BMJ!!

Michael C Bunbury, et al.
bmj.com, 30 Jun 2003 [Full text]

Nearer 66% rather than 88% IHD risk reduction after 2 years?

Eric S. Kilpatrick
bmj.com, 30 Jun 2003 [Full text]

Relative risks and meta-analysis

J Michael Henk
bmj.com, 30 Jun 2003 [Full text]

Unbelievable and unachievable

Mark J Garton
bmj.com, 30 Jun 2003 [Full text]

Multiple Polypill Benefits

Gerard T O'Brien
bmj.com, 1 Jul 2003 [Full text]

WHO should convene an aspirin meeting?

Gareth P Morgan
bmj.com, 1 Jul 2003 [Full text]

POLYPILL AGAIN,BUT IN THE THIRD WORLD

CELIO LEVYMAN,MD,MSc
bmj.com, 2 Jul 2003 [Full text]

Patients before populations

Peter N Trewby, et al.
bmj.com, 2 Jul 2003 [Full text]

Polypill treatment and the physical properties of blood.

Leslie.O. Simpson
bmj.com, 2 Jul 2003 [Full text]

Re: Shame on you BMJ!!

Daniel Weyandt
bmj.com, 2 Jul 2003 [Full text]

Reality check

Mike Schachter
bmj.com, 2 Jul 2003 [Full text]

Brave New World

Joachim P Sturmberg
bmj.com, 2 Jul 2003 [Full text]

Polypill Choices

Shah M Tauzeeh
bmj.com, 2 Jul 2003 [Full text]

Concept is correct

Paul W Masters
bmj.com, 2 Jul 2003 [Full text]

Logical consequence of current polypharmacy

Dr. Matthew L Grove
bmj.com, 2 Jul 2003 [Full text]

What must be done now.

William Plummer
bmj.com, 2 Jul 2003 [Full text]

Aspastatapril vs Polypill

Ketan K Dhatariya
bmj.com, 2 Jul 2003 [Full text]

Compliance with the Polypill

Anita Sainsbury
bmj.com, 3 Jul 2003 [Full text]

Re: What must be done now - correction.

William Plummer
bmj.com, 3 Jul 2003 [Full text]

Is The Paper a Spoof?

David A Brodie
bmj.com, 3 Jul 2003 [Full text]

Dubious mathematical assumptions

David M Reith
bmj.com, 3 Jul 2003 [Full text]

Total Mortality

Jeffrey R Johnstone
bmj.com, 4 Jul 2003 [Full text]

Modelling and assumptions need clarification

Tom Fahey, et al.
bmj.com, 5 Jul 2003 [Full text]

Polypill Debate

Stephen J Redmond
bmj.com, 5 Jul 2003 [Full text]

Cat amonsgt the pigeons

Adam L Brown
bmj.com, 5 Jul 2003 [Full text]

Eradicating cardiovascular disease with polypharmarcy: Dream or reality ?

Peter Marckmann
bmj.com, 6 Jul 2003 [Full text]

Willing suspense of disbelief

Elved B Roberts
bmj.com, 7 Jul 2003 [Full text]

'Magic pill' approach would shift focus from proven and cost-effective CVD prevention

Derek Yach, et al.
bmj.com, 7 Jul 2003 [Full text]

Salicylate deficiency

Gareth P Morgan
bmj.com, 7 Jul 2003 [Full text]

we should ask patients

Alejandro F. Luque-Coqui
bmj.com, 8 Jul 2003 [Full text]

Reducing cardiovascular disease by taking a "polypill" hope or hype?

Marcus Flather, et al.
bmj.com, 9 Jul 2003 [Full text]

The Polypill and prevention of Coronary Heart Disease

Daan Kromhout, et al.
bmj.com, 10 Jul 2003 [Full text]

Re: PolyPill may not decrease all-cause mortality

Alejandro F. Luque-Coqui
bmj.com, 10 Jul 2003 [Full text]

The fundamental principle of western medical science is the principle of scientific testing

Jeffrey Mann
bmj.com, 10 Jul 2003 [Full text]

Polypill for older adults.

Nandkishor V Athavale
bmj.com, 10 Jul 2003 [Full text]

Polypill versus conventional preventive care

Barry Lewis
bmj.com, 11 Jul 2003 [Full text]

Misplaced notions of simplicity, denial of complexity

Lawrence J. O'Brien, et al.
bmj.com, 11 Jul 2003 [Full text]

Incredulous of middle England !!

Saul G Myerson
bmj.com, 11 Jul 2003 [Full text]

Re: Re: Shame on you BMJ!!

Michael Bunbury
bmj.com, 12 Jul 2003 [Full text]

Questionable benefit from polypill treatment.

Uffe Ravnskov
bmj.com, 13 Jul 2003 [Full text]

The ‘polypill’: medical myth versus balanced judgement

Ian F Godsland, et al.
bmj.com, 14 Jul 2003 [Full text]

CARDIOVASCULAR PREVENTION AND THERAPY

Andrea Alberto Conti, et al.
bmj.com, 15 Jul 2003 [Full text]

Poly-drug to reduce cardiovascular disease

Dietmar Fuchs, et al.
bmj.com, 18 Jul 2003 [Full text]

The wonderful poly-pill

Miguel E. Campos, et al.
bmj.com, 19 Jul 2003 [Full text]

Potential Issues

Robert Kerr
bmj.com, 23 Jul 2003 [Full text]

Concept of Poly-Pill contrary to medical judgement

Munir E Nassar, M.D., et al.
bmj.com, 25 Jul 2003 [Full text]

The Nays Have It

John A. DePoy, BS, MSc, MBA, et al.
bmj.com, 26 Jul 2003 [Full text]

The “polypill” strategy in high-risk Australian CVD patients

Christopher M Reid, et al.
bmj.com, 28 Jul 2003 [Full text]

Markov models deserve scientific scrutiny too.

Christopher J Martin, et al.
bmj.com, 29 Jul 2003 [Full text]

Noncompliance with hypertensives

Christopher J Squire
bmj.com, 30 Jul 2003 [Full text]

Risks with the "Polypill" in the Oldest Old

Sven E Nilsson, et al.
bmj.com, 13 Aug 2003 [Full text]

delay vs prevention

gerry e burns
bmj.com, 15 Aug 2003 [Full text]

Why not Omega-3 fatty acid as part of Polypill ?

William K Smith M D
bmj.com, 17 Aug 2003 [Full text]

Enter...The 'Omnipill'

Joseph .C. Obi
bmj.com, 18 Aug 2003 [Full text]

Omega-3 fatty acids and brown fat.

Richard G Fiddian-Green
bmj.com, 19 Aug 2003 [Full text]

We are headed toward a healthcare crisis fast enough, thank you.

Philip King, D.Ph.
bmj.com, 20 Aug 2003 [Full text]

A natural mini polypill: Potential impact on population cardiovascular risk of a daily drink of milk

Gary A Wright, et al.
bmj.com, 22 Aug 2003 [Full text]

The Polypill and Ayurdeva

Rajeev Gupta
bmj.com, 28 Aug 2003 [Full text]

What's really behind the antagonism for the polypill?

James G Penston
bmj.com, 1 Sep 2003 [Full text]

drug interactions

Teresa Tarnowski Goodell, RN
bmj.com, 18 Sep 2003 [Full text]

Reducing Cardiovascular Disease

William E. Feeman Jr., et al.
bmj.com, 19 Sep 2003 [Full text]

polypill - why not ? polypharmarcy is practised !

das sabapathy
bmj.com, 4 Oct 2003 [Full text]

Methodological issues remain unanswered

Tom Fahey, et al.
bmj.com, 31 Oct 2003 [Full text]

Polypill-Pr, a new formulation for the mature male

A. Mark Clarfield
bmj.com, 30 Jan 2004 [Full text]

Re: Polypill- adding osteporosis treatment restores gender equality at 8 all

Jeremy G Jones
bmj.com, 1 Feb 2004 [Full text]

Methodological issues remain unanswered - Authors' response

Nicholas J Wald, et al.
bmj.com, 8 Mar 2004 [Full text]

Polypill a life…in

Guy-André Pelouze
bmj.com, 19 Mar 2004 [Full text]