Article Impact Level: HIGH Data Quality: STRONG Summary of BMJ, r208. https://doi.org/10.1136/bmj.r208 Dr. Rachel E. Jordan et al.
Points
- The study examines the use of a polypill containing blood pressure-lowering agents, statins, and anti-platelet medications to prevent heart attacks and strokes, potentially reducing cardiovascular events by 80%.
- Randomized trials show that the polypill lowers systolic blood pressure by 20 mm Hg, diastolic pressure by 10 mm Hg, and LDL cholesterol by 40%, making it a more effective prevention tool than traditional NHS health checks.
- The polypill reduced major cardiovascular events by 33% over five years, with reductions reaching 56% among highly adherent participants, demonstrating its strong protective effects.
- Modeling studies indicate that the polypill approach, with full adherence, could result in 2,528 person-years gained per 1,000 individuals—more than double the benefits of the current NHS screening program.
- Despite its potential, the polypill faces barriers such as resistance from healthcare providers and the public’s preference for personalized care, necessitating a large-scale demonstration project before broader adoption.
Summary
This study explores the potential impact of a polypill approach for the primary prevention of heart attacks and strokes, focusing on the use of a combined pill containing blood pressure-lowering agents, statins, and anti-platelet medications. The polypill was first proposed in 2000 and aims to prevent 80% of heart attacks and strokes. In randomized trials, the polypill has shown effective reductions in systolic blood pressure by about 20 mm Hg, diastolic pressure by 10 mm Hg, and LDL cholesterol by around 40%. This combination therapy, offered to individuals aged 50 and older, could be a powerful strategy to prevent cardiovascular diseases and reduce healthcare costs, especially compared to the current NHS health check program, which is limited by low uptake and poor adherence.
In the PolyIran trial, the polypill reduced the risk of major cardiovascular events by 33% over five years, with even higher reductions (up to 56%) among the most adherent participants. The study also highlighted the greater benefit of the polypill compared to the NHS health check program, which currently offers medication only to individuals at higher risk, missing many people who eventually develop cardiovascular disease. A modeling study showed that with 100% adherence, the polypill approach would result in 2,528 person-years gained per 1,000 individuals, significantly higher than the 1,148 person-years gained through the current health check screening.
Despite its potential, the polypill approach faces several barriers to implementation, including resistance from healthcare professionals and the public’s preference for personalized risk assessment. A shift toward a more universal preventive strategy would require policy changes and could be facilitated through primary care. The authors argue that a large-scale, publicly funded demonstration project is necessary to evaluate uptake and adherence before a broader rollout, positioning the polypill as a cornerstone of disease prevention strategies to reduce heart attacks and strokes effectively.
Link to the article: https://www.bmj.com/content/388/bmj.r208
References Jordan, R. E., Hingorani, A. D., & Wald, N. J. (2025). Primary prevention of heart attacks and strokes: Seeking consensus on the polypill approach. BMJ, r208. https://doi.org/10.1136/bmj.r208
