Editorials

Whatever happened to the polypill?

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1474 (Published 27 March 2017) Cite this as: BMJ 2017;356:j1474
  1. Anthony J Viera, professor
  1. Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA
  1. anthony_viera{at}med.unc.edu

The idea is slowly but surely gaining ground

It has been nearly 15 years since Wald and Law proposed that a polypill could reduce cardiovascular events if taken by everyone from the age of 55 years (primary prevention) and all people with pre-existing cardiovascular disease (secondary prevention).1 Initial responses to the idea were mixed, with most who voiced opinions expressing opposition, some citing lack of trial data to support the “spectacular claims.”2 Others were enthusiastic about the idea’s potential, and since the 2003 publication several polypill trials have shown tolerability and benefit on intermediate and some clinical outcomes.3456 In the recent HOPE-3 trial67 a polypill reduced cardiovascular events by 29% over about 5.6 years in adults at moderate risk of cardiovascular disease (3.6% v 5.0%; P=0.005). Although overall benefit was driven by the statin, those with higher blood pressure benefited from blood pressure lowering as well.

The use of a polypill for secondary prevention, typically as a substitute for individual drugs, has …

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