The Polypill at 20 — What Have We Learned?

This editorial reflects on two decades of the polypill concept originating with Wald and Law in 2003 originally envisioned as a universal fixed-dose cardiovascular prevention pill for adults over 55. While initial reactions included concerns about overmedication and neglect of lifestyle factors, subsequent evolution emphasized the use of polypills for secondary prevention, where treatment is already indicated. The SECURE trial addressed prior limitations by demonstrating improved cardiovascular outcomes with a polypill containing aspirin, ramipril, and atorvastatin versus usual care in post–myocardial infarction patients. Despite similar LDL and blood pressure levels between groups, better medication adherence in the polypill arm likely contributed to outcome superiority. The trial also offered dose flexibility, with multiple versions available, and called for further simplification—such as including dual antiplatelet therapy. The editorial argues that polypills are now proven safe and effective in secondary prevention and urges broader adoption, especially given their potential to improve adherence, reduce event rates, and streamline prescribing. Still, practical implementation hurdles remain, including limited commercial investment and unresolved questions about mass preventive deployment.

This editorial reflects on two decades of the polypill concept originating with Wald and Law in 2003 originally envisioned as a universal fixed-dose cardiovascular prevention pill for adults over 55. While initial reactions included concerns about overmedication and neglect of lifestyle factors, subsequent evolution emphasized the use of polypills for secondary prevention, where treatment is already indicated. The SECURE trial addressed prior limitations by demonstrating improved cardiovascular outcomes with a polypill containing aspirin, ramipril, and atorvastatin versus usual care in post–myocardial infarction patients. Despite similar LDL and blood pressure levels between groups, better medication adherence in the polypill arm likely contributed to outcome superiority. The trial also offered dose flexibility, with multiple versions available, and called for further simplification—such as including dual antiplatelet therapy. The editorial argues that polypills are now proven safe and effective in secondary prevention and urges broader adoption, especially given their potential to improve adherence, reduce event rates, and streamline prescribing. Still, practical implementation hurdles remain, including limited commercial investment and unresolved questions about mass preventive deployment.