ReviewEvolution of the Polypill Concept and Ongoing Clinical Trials
Section snippets
The Polypill: Evolution of a Concept
Fixed-dose combination (FDC) drugs have been present in the therapeutic armamentarium for several decades, particularly for the treatment of hypertension. However, its use declined, mainly because the impossibility of adapting treatment to each patient's needs. At the beginning of the present century, several authors proposed the use of FDCs for CVD prevention.7 The term, ‘polypill,’ was coined by Wald and Law in a seminal paper published in 2003,8 who claimed that a FDC comprised of 6
Rationale for the Components of the Polypill
Aspirin, statins, ACE inhibitors, and β-blockers are routinely administered in all patients recovering from an acute MI who do not have contraindications to these drugs. Data from the Antiplatelet Trialists' Collaboration demonstrated that after an MI, for every 1000 patients treated with aspirin, 18 nonfatal infarctions, 5 nonfatal strokes, and 14 vascular deaths are prevented.31 The Cholesterol Treatment Trialists' Collaboration analyzed the efficacy and safety of statins in 14 randomized
Potential Benefit of a Polypill in CVD Prevention
The projected effect of polypill use among US adults has been explored by Muntner et al.35 Using population-based survey data, they found that 67.6 million US adults would be eligible if the polypill were given to everyone at least 55 years of age, and 15.4 million would be eligible if the pill were given to those with a history of CVD. By multiplying estimated risk reductions, they estimated this could reduce the 10-year incidence of coronary heart disease and stroke by 44% and 37%,
Conclusions
The deteriorating health of the population and the increasing prevalence of chronic diseases is a global problem with causes that are multifactorial and complex. Interventions to promote healthy lifestyles have proven to be effective, and national campaigns and health policies can make an important contribution to controlling risk factor levels in the general population. However, the evolution from a global landscape where death and morbidity are now dominated by CVD and other noncommunicable
Disclosures
The authors have no conflicts of interest to disclose.
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Cited by (17)
The Fuster-CNIC-Ferrer Cardiovascular Polypill: a polypill for secondary cardiovascular prevention
2015, International Journal of CardiologyGlobal burden of CVD: Focus on secondary prevention of cardiovascular disease
2015, International Journal of CardiologyA polypill strategy to improve global secondary cardiovascular prevention: From concept to reality
2014, Journal of the American College of CardiologyCitation Excerpt :In this scenario, the healthcare systems of LMIC, which do not have the means to ensure adequate patient services, can adopt the polypill strategy because patients should be able to manage it autonomously. In settings with fewer resources, a polypill strategy is potentially critical considering that a 1-month supply of standard generic secondary prevention medications can cost a government worker in a low-income country approximately 1.6 to 18.4 days of work wages (40). From a business model point of view, one of the major appeals of an FDC polypill is the use of low-cost mature drugs in an efficient manner.
increasing appreciation for the role of single-pill combinations for the prevention of atherosclerotic disease: A pro-polypill polemic
2014, Canadian Journal of CardiologyCitation Excerpt :We can argue theory as much as we want, but ultimately the value of the polypill approach will be determined by prospective randomized clinical trials assessing its effects on clinically important hard end points. Several such trials are under way—the interested reader is referred to a detailed review article discussing them in this issue of the Canadian Journal of Cardiology.12 Following on Wald and Law's seminal thesis now more than a decade ago, we have ample evidence that a multiple-drug (poly) pill is a theoretically and practically highly effective approach to primary prevention (for high-risk individuals), and for secondary prevention.
Polypill Therapy for Cardiovascular Disease Prevention and Combination Medication Therapy for Hypertension Management
2023, Journal of Clinical Medicine
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