Publications

Primary prevention is recognized as the “holy grail” in combating the global burden of cardiovascular diseases (CVD) and will play an important role in achieving World Heart Federation's goal of reducing premature mortality from CVD by 25 % by 2025. Current primary prevention strategies, which focus on treating cardiovascular risk factors to set targets and individualizing treatments, are impractical for wide application at a population level. The “polypill” hypothesis of Wald and Law (2003)– that treating all people above 55 years of age with a fixed-dose combination of medication targeting at least two risk factors in a single pill could reduce CVD by 80 % – has generated both great hope and controversy. The concept is based on the premise that risk factors tend to cluster and that the level of risk is continuous with no inflection point. In addition, a once–a–day pill will likely improve patient medication adherence. Proof–of–concept trials have been undertaken and these have demonstrated initial successes and a few setbacks. Based on evidence from these studies, the polypill has been approved by regulatory agencies in some countries for secondary prevention. Large phase 3 primary prevention trials evaluating the efficacy of the polypill on clinical outcomes are underway. Today, there are at least five formulations of the polypill available. If the pivotal phase 3 trials prove to be successful in reducing clinical outcomes, a combination of the polypill strategy combined with a reorientation of the health system for effective delivery of the polypill could prove to be the most effective weapon in the armamentarium to achieve primary CVD prevention and reduce premature mortality from CVD.