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“The polypill!”

Posted by plosmedicine on 31 Mar 2009 at 00:17 GMT

Author: Elsayed Z. Soliman MD, MSc
Position: Researcher
Institution: Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC
Additional Authors: Omaima A. Shalash PhD
Submitted Date: December 04, 2007
Published Date: December 5, 2007
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Improving health is a hard task to accomplish even in rich countries. Hence, trying to offer it to individuals living on less than 1 dollar a day is too difficult to imagine. However, to make it imaginable, we have to look at “improving health” as if being equal to “preventing diseases”. Although “health” is not simply equal to “absence of disease”, the simplicity of approximation would make it easier to imagine a solution. Furthermore, to have a cost-effective strategy to achieve “absence of disease”, it is a must to prioritize interventions based on the impact of diseases in terms of population attributable risk which represents the proportion of the deaths in the whole population that may be preventable if a cause of mortality were totally eliminated.

In this context, cardiovascular disease (CVD) would have the top priority. CVD is the number one cause of death globally and is projected to remain the leading cause of death. An estimated 17.5 million people died from cardiovascular disease in 2005, representing 30 % of all global deaths. Around 80% of these deaths occurred in low and middle income countries (1) where many people are living under 1 dollar a day.

Despite the huge size of CVD problem, there are some interesting strategies that would fit those living under 1 dollar a day. The combination pill referred as the “polypill” comprising a statin, 3 antihypertensive agents at half doses (a ß-blocker, a diuretic, and an angiotensin-converting enzyme inhibitor), aspirin (75 mg), and folic acid (0.8 mg)) has the potential of providing a cost-effective prevention of cardiovascular disease (2) Using the “polypill” would achieve a more than 80% reduction in cardiovascular events if applied to everyone older than 55 years.(2) The cost of such a pill is definitely less than 1 dollar a day given the availability of all the polypill in generic forms. Additionally, the claimed benefits of the polypill do not require screening for risk factors or specialists visit, another huge cost saving. Furthermore, when the patients go to get their pill, this would be a chance to advise them on healthy diet and smoking cessation, interventions that have the potential to augment the benefit of the polypill.


(1) World Health Organization. Accessed on December 4, 2007

(2) Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ. 2003; 326:1419.

Competing interests declared: EZ Soliman is an investigator in a "polypill" clinical trial to be conducted in Sri Lanka