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A strategy to reduce cardiovascular disease by more than 80%.
BMJ. 2003 Jun 28; 326(7404):1419.BMJ

Abstract

OBJECTIVES

To determine the combination of drugs and vitamins, and their doses, for use in a single daily pill to achieve a large effect in preventing cardiovascular disease with minimal adverse effects. The strategy was to simultaneously reduce four cardiovascular risk factors (low density lipoprotein cholesterol, blood pressure, serum homocysteine, and platelet function) regardless of pretreatment levels.

DESIGN

We quantified the efficacy and adverse effects of the proposed formulation from published meta-analyses of randomised trials and cohort studies and a meta-analysis of 15 trials of low dose (50-125 mg/day) aspirin.

OUTCOME MEASURES

Proportional reduction in ischaemic heart disease (IHD) events and strokes; life years gained; and prevalence of adverse effects.

RESULTS

The formulation which met our objectives was: a statin (for example, atorvastatin (daily dose 10 mg) or simvastatin (40 mg)); three blood pressure lowering drugs (for example, a thiazide, a beta blocker, and an angiotensin converting enzyme inhibitor), each at half standard dose; folic acid (0.8 mg); and aspirin (75 mg). We estimate that the combination (which we call the Polypill) reduces IHD events by 88% (95% confidence interval 84% to 91%) and stroke by 80% (71% to 87%). One third of people taking this pill from age 55 would benefit, gaining on average about 11 years of life free from an IHD event or stroke. Summing the adverse effects of the components observed in randomised trials shows that the Polypill would cause symptoms in 8-15% of people (depending on the precise formulation).

CONCLUSION

The Polypill strategy could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing cardiovascular disease. It would be acceptably safe and with widespread use would have a greater impact on the prevention of disease in the Western world than any other single intervention.

Links

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Authors+Show Affiliations

Wald NJ
Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and the London, Queen Mary's School of Medicine and Dentistry, University of London, London EC1M 6BQ. n.j.wald@qmul.ac.uk
Law MR
No affiliation info available

MeSH

AdultAgedAged, 80 and overAntihypertensive AgentsAspirinDrug CombinationsFemaleFolic AcidHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedMyocardial IschemiaPlatelet Aggregation InhibitorsRandomized Controlled Trials as TopicRisk FactorsStroke

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

12829553

Clinical Trial Links

Treatment of Coronary Heart Disease With Amiloride
Prevention of Cardiovascular Disease in Middle-aged and Elderly Iranians Using a Single PolyPill
Prevention of Cardiovascular Disease With Polypill Among Pars Cohort Participants
Fixed Dose Combination Drug (Polypill)for Secondary Cardiovascular Prevention.

Citation

Wald, N J., and M R. Law. "A Strategy to Reduce Cardiovascular Disease By More Than 80%." BMJ (Clinical Research Ed.), vol. 326, no. 7404, 2003, p. 1419.
Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ. 2003;326(7404):1419.
Wald, N. J., & Law, M. R. (2003). A strategy to reduce cardiovascular disease by more than 80%. BMJ (Clinical Research Ed.), 326(7404), 1419.
Wald NJ, Law MR. A Strategy to Reduce Cardiovascular Disease By More Than 80%. BMJ. 2003 Jun 28;326(7404):1419. PubMed PMID: 12829553.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A strategy to reduce cardiovascular disease by more than 80%. AU - Wald,N J, AU - Law,M R, PY - 2003/6/28/pubmed PY - 2003/7/23/medline PY - 2003/6/28/entrez SP - 1419 EP - 1419 JF - BMJ (Clinical research ed.) JO - BMJ VL - 326 IS - 7404 N2 - OBJECTIVES: To determine the combination of drugs and vitamins, and their doses, for use in a single daily pill to achieve a large effect in preventing cardiovascular disease with minimal adverse effects. The strategy was to simultaneously reduce four cardiovascular risk factors (low density lipoprotein cholesterol, blood pressure, serum homocysteine, and platelet function) regardless of pretreatment levels. DESIGN: We quantified the efficacy and adverse effects of the proposed formulation from published meta-analyses of randomised trials and cohort studies and a meta-analysis of 15 trials of low dose (50-125 mg/day) aspirin. OUTCOME MEASURES: Proportional reduction in ischaemic heart disease (IHD) events and strokes; life years gained; and prevalence of adverse effects. RESULTS: The formulation which met our objectives was: a statin (for example, atorvastatin (daily dose 10 mg) or simvastatin (40 mg)); three blood pressure lowering drugs (for example, a thiazide, a beta blocker, and an angiotensin converting enzyme inhibitor), each at half standard dose; folic acid (0.8 mg); and aspirin (75 mg). We estimate that the combination (which we call the Polypill) reduces IHD events by 88% (95% confidence interval 84% to 91%) and stroke by 80% (71% to 87%). One third of people taking this pill from age 55 would benefit, gaining on average about 11 years of life free from an IHD event or stroke. Summing the adverse effects of the components observed in randomised trials shows that the Polypill would cause symptoms in 8-15% of people (depending on the precise formulation). CONCLUSION: The Polypill strategy could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing cardiovascular disease. It would be acceptably safe and with widespread use would have a greater impact on the prevention of disease in the Western world than any other single intervention. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/12829553/A_strategy_to_reduce_cardiovascular_disease_by_more_than_80_ DB - PRIME DP - Unbound Medicine ER -