Editor—Rarely has the demand for empirical evidence of treatment benefit been as necessary as in the prevention of cardiovascular disease. Wald and Law doubt this approach, saying that a “Polypill” containing six drugs would reduce events of ischaemic heart disease by 88% and stroke by 80% and might therefore be given with impunity to everyone aged 55 and older and to everyone with existing cardiovascular disease.1
They think that this might have a greater impact on the prevention of disease in the Western world than any other single intervention.
That's impressive.
But a note of caution.
Treatment effects are determined in randomised controlled clinical trials, taking non-compliance and the range of dose responses into account. You cannot extrapolate the result that would be expected with 100% compliance, counting only those with a maximum reduction in risk factors. Thus the expected 61% reduction in events of ischaemic heart disease from cholesterol lowering by using statins is about twice that yet seen in any trial.
Equally, blood pressure lowering trials reduced the risk of ischaemic heart disease by about 20%, not 46%. Trial evidence for antithrombotic treatment is weaker and does not exist for folate. Trial data on the Polypill are, of course, lacking.
How nice it would be to live in a Polypill world. One for heart disease, one for mood, and maybe even one for finding the right partner. In reality, however, we must deal with each problem in turn, often accepting a less than perfect result. There are no quick fixes, in life or in medicine, and lowering cardiovascular risk is no exception.
Competing interests: None declared.
References
- 1.Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ 2003;326: 1419-24. (28 June.) [DOI] [PMC free article] [PubMed] [Google Scholar]