"Polypill" to fight cardiovascular disease: Interpretation of trial data is optimistic

doi:10.1136/bmj.327.7418.808-b

BMJ 2003;327:808 (4 October), doi:10.1136/bmj.327.7418.808-b

Letter

"Polypill" to fight cardiovascular disease

Interpretation of trial data is optimistic

The first 150 words of the full text of this article appear below.

EDITOR—Rarely has the demand for empirical evidence oftreatment benefit been as necessary as in the prevention ofcardiovascular disease. Wald and Law doubt this approach, sayingthat a "Polypill" containing six drugs would reduce events ofischaemic heart disease by 88% and stroke by 80% and might thereforebe given with impunity to everyone aged 55 and older and toeveryone with existing cardiovascular disease.¹

They think that this might have a greater impact on the preventionof disease in the Western world than any other single intervention.

That's impressive.

But a note of caution.

Treatment effects are determined in randomised controlled clinicaltrials, taking non-compliance and the range of dose responsesinto account. You cannot extrapolate the result that would beexpected with 100% compliance, counting only those with a maximumreduction in risk factors. Thus the expected 61% reduction inevents of ischaemic heart disease . . . [Full text of this article]

Gerd Assmann, professor of laboratory medicine

assmann@uni-muenster.de

Paul Cullen, research physician, Helmut Schulte, statistician

Institute of Arteriosclerosis Research, University of Münster, Domagkstrasse 3, D-48149 Münster, Germany