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The Polypill Approach
October  2019

In these times of personalized medicine it seems a bit heretical to discuss a “one size fits all” strategy like the polypill, but a recent publication reminds us of the disease prevention potential of the approach. One of the original papers and the one naming the polypill was published in 2003. The authors proposed low dose medications to reduce cholesterol, blood pressure, serum homocysteine and platelet “stickiness” to reduce and delay the major killers — stroke and cardiovascular disease.

The recent study was a randomized prospective trial comparing a minimal care group (training on healthy lifestyle) and a group with lifestyle training and a daily polypill. The polypill group (those that took the pill) had a reduction in major cardiovascular events with a hazard ratio of .43 over the 60 months of follow-up when compared to the lifestyle only group.

There was no difference in adverse side effects with the polypill. This experiment took place in rural areas of a low to middle income country where access to personalized care may not be readily available. More studies are needed, but as obesity continues to increase in low and moderate income countries, a strategy like the polypill may be effective in counteracting the associated rise in cardiovascular disease.

In this edition of Housecalls Dr. Rosace discusses another “one size fits all” prevention strategy — routine vaccinations. She relates the importance of herd immunity and warns of a tipping point when we may see the re-emergence of some previously conquered diseases. I share a case of intracranial aneurysm with a family history, and Dr. Kadouch provides us with a challenging ECG.

  • Roshandel G et al, “Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial,” Lancet 2019;394:672-83.
  • Wald NJ et al, “A strategy to reduce cardiovascular disease by more than 80%,” BMJ 2003;326:1419-23.