title: A polypill for all? Critical review of the polypill literature for primary prevention of cardiovascular disease and stroke.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of the polypill for prevention of cardiovascular disease (CVD) and stroke and to present literature related to the polypill components (statin, aspirin, antihypertensive) for primary prevention of CVD and stroke.
  
  
  METHODS
  A literature search was conducted in MEDLINE (1948-January 2011) and EMBASE (1974-January 2011) using the terms polypill and Polycap. When limited to clinical trials, systematic reviews, or meta-analyses, 7 studies were identified. Bibliographies of pertinent review articles and studies were scanned for additional references. A similar search was conducted to identify literature related to the use of polypill components for primary prevention of CVD and stroke.
  
  
  METHODS
  Studies that evaluated the hypothetical benefits of a polypill and controlled trials that assessed a formulation of the polypill related to prevention of CVD and stroke were included. Studies were assessed for efficacy, safety, drug interactions, and clinical pharmacokinetics.
  
  
  RESULTS
  An initial study to predict benefit estimated that a hypothetical polypill would reduce diastolic blood pressure by 11 mm Hg and low-density lipoprotein cholesterol (LDL-C) by 70 mg/dL, thus reducing the relative risks of CVD and stroke by 88% and 80%, respectively. One clinical trial in patients at low risk for CVD and stroke found that diastolic blood pressure was reduced by 1.6 mm Hg and LDL-C was reduced by 17.7 mg/dL, correlating with 44% and 21% reduction in the relative risks of CVD and stroke, respectively. Studies in higher risk patients reported reductions in systolic blood pressure of up to 28.8 mm Hg and in LDL-C of up to 54 mg/dL, correlating with 62% and 60% relative reduction in risks of CVD and stroke, respectively.
  
  
  CONCLUSIONS
  Polypill study results have been more modest than originally theorized. However, results show promise in patients at higher risk for CVD and stroke.
authors.affiliation: Massachusetts College of Pharmacy and Health Sciences, Worcester, MA, USA. katherine.carey@mcphs.edu
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Carey
authors.forename: Morgan R
authors.initials: MR
authors.lastname: Comee
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Donovan
authors.forename: Abir O
authors.initials: AO
authors.lastname: Kanaan
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D001262:Atenolol / Q000008:administration & dosage / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000517:prevention & control*; D004338:Drug Combinations; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D011322:Primary Prevention / Q000379:methods*; D017257:Ramipril / Q000008:administration & dosage / Q000627:therapeutic use; D019821:Simvastatin / Q000008:administration & dosage / Q000627:therapeutic use; D020521:Stroke / Q000188:drug therapy / Q000517:prevention & control*
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors; D006852:Hydrochlorothiazide; D001262:Atenolol; D019821:Simvastatin; D017257:Ramipril; D001241:Aspirin