Prospects and possible pitfalls of a preventive Polypill: confessions of a health promotion convert

Abstract

A proposal by Wald and Law (2003) for a single pill containing a statin, three half-dose antihypertensives, aspirin, and folic acid, met with a storm of controversy and seemed to have been relegated as much to the fanciful as to the accolades it might have deserved. The benefits such a Polypill could confer on people age 55 þ y were to reduce both cardiovascular and stroke events by 80% or more. Considering the daunting and, at best, slow process of changing the same risk factors through health promotion interventions on food policy, dietary and physical activity behaviors, and urban planning to make less prevalent the sedentary lifestyles developed over decades, the argument here is to view the Polypill as a harm reduction strategy that would complement health promotion, as Nicotine Replacement Therapy did for tobacco control, seat belts did for traffic injuries, and needle exchange programs did for secondary complications of injection drug use.

The polypill to prevent cardiovascular disease

“…Green) wrote a thoughtful article in which he speculated that part of professionals' response to the polypill strategy would be resistance because of a concern that it might detract from the lifestyle changes (e.g. eating a healthy diet) that people should undertake to promote good health [11]. Green asserted that early primary prevention (e.g.…”

“…thoughtful consideration ensued, during which publications emerged highlighting not only the potential disadvantages, but the potentially large upsides surrounding the concept. Following thoughtful consideration, some physicians and other health professionals emerged as converts, and advocated for clinical trials to evaluate the effectiveness of the polypill [10,11]. We are now in the era of clinical trials.…”

Effect of Pollypill on cardiovascular parameters: Systematic review and meta-analysis

“…Several formulation of Pollypill have been developed thereafter, and clinical trials were also initiated regardless of emerging controversy on Pollypill to an extent that few researchers suggested that Pollypill might be detrimental for modern medicine. 8 This article aims to present the current best evidences regarding the use of Pollypill in CVD by systematic review and meta-analysis of available clinical trials on Pollypills.…”