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Polypill: a harmonious blend of stoicism and pragmatism in primary cardiovascular prevention
  1. Milad Nazarzadeh
  1. Deep Medicine, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
  1. Correspondence to Milad Nazarzadeh, Deep Medicine, Nuffield Dept.of Women's & Reproductive Health, University of Oxford, Oxford, UK; milad.nazarzadeh{at}

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Despite the existence of well-established risk factors and effective pharmacological treatments for major cardiovascular disease (CVD), these conditions remain among the leading causes of premature death and disability, exerting a substantial burden on health systems worldwide. Previous randomised studies have provided compelling evidence for the efficacy of blood pressure and lipid-lowering treatments in reducing the risk of CVD, suggesting unique opportunities for the prevention of this chronic and prevalent disease through affordable and accessible pharmacological treatment approaches.1 2 Although reports from some western countries show gradual, yet suboptimal, improvements in the CVD burden, the situation in the rest of the world remains challenging.3 This indicates an unmet need for effective, accessible and cost-effective strategies to address this global health issue.

However, given the chronic nature of CVD, which necessitates prolonged treatment regimens, achieving and maintaining an optimal level of prevention through pharmacological treatment often presents significant challenges, especially for primary prevention at the population level. Fixed-dose combination therapy refers to a treatment strategy in which multiple active pharmacological ingredients are combined into a single pill (polypill) to target different risk factors and pathways simultaneously. This strategy is primarily used to improve medication adherence and simplify treatment regimens. This approach is not a new concept; it has been used for several decades, most successfully in the treatment of HIV/AIDS, where combination antiretroviral therapy consolidates multiple antiretroviral drugs into a single pill, yielding game-changing results. For CVD prevention, although the randomised evidence appears convincing for secondary prevention, the application of this strategy for primary prevention at the population level in different settings remains …

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  • X @MiladNazarzadeh

  • Funding MN is supported by a research fellowship from the British Heart Foundation (grant number FS/IPBSRF/22/27060).

  • Competing interests MN is the statistical and methodological advisor for the Heart BMJ journal. MN has previously received reimbursement and honoraria from AstraZeneca, Nemysis and Albus Health outside the submitted work.

  • Provenance and peer review Commissioned; internally peer reviewed.

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