Polypill strategy for primary prevention of cardiovasculardisorders

Cardiovascular diseases are responsible for a significant proportion of global mortality and morbidity. Modifiable risk factors like hypertension, hyperlipidemia, physical inactivity, unhealthy diet, tobacco use, obesity and inflammatory states contribute to an increased risk of cardiovascular diseases. The mortality risk increases with increase in number of risk factors. So, simultaneous modification of multiple risk factors is expected to reduce mortality due to these disorders more than the reduction of any individual risk factor. Based on the same rationale, the polypill strategy is based on utilizing a once-daily fixed-dose combination pill to reduce multiple cardiovascular risk factors simultaneously. Two cardiovascular epidemiologists, Wald and Law, proposed the strategy in a patent application in 2000. The idea of combining multiple medications to improve efficacy of treatment has been effectively applied in the treatment of many cancers, HIV/AIDS, tuberculosis and malaria. However, such combination strategy has not been tested in preventing a chronic disease. Thus, this idea has generated a lot of interest as well as controversy. In this article, we will review the pharmacokinetics, clinical trials, advantages and limitations of the polypill strategy.