20th September 2019, Volume 132 Number 1502

Vanessa Selak, Bruce Arroll, Chris Bullen, Rob Doughty, Corina Grey, Matire Harwood, Sue Crengle

Cardiovascular disease (CVD) is one of the major causes of mortality, morbidity and inequities globally. The World Health Organization (WHO)’s action plan to reduce the burden of CVD, as well…

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Summary

Aspirin, statins and blood pressure-lowering medication are recommended for most people who have already had a cardiovascular event (such as a heart attack or stroke) as these medications substantially reduce their risk of having another one. Unfortunately a lot of people are missing out on these medications. One way to improve access to medications is by combining them into a single pill or capsule (a “polypill”). Despite considerable evidence supporting the safety and effectiveness of polypills for people who have already had a cardiovascular event they are not currently funded by PHARMAC.

Abstract

Wald and Law, who popularised the term ‘polypill’ in 2003, proposed giving everyone above a certain age a polypill to reduce the burden of cardiovascular disease (CVD). A more compelling potential application, proposed in 2001 by the World Health Organization, is to use a polypill containing antiplatelet, statin and blood pressure-lowering therapy among people with established CVD, in whom the components are already indicated but in whom guideline implementation and adherence are suboptimal. This article outlines relevant international and New Zealand evidence on the likely benefits and harms of a polypill for the secondary prevention of CVD. The evidence indicates that the benefits are likely to outweigh the harms, particularly given the persistence of substantial treatment gaps and inequities in the management of and outcomes in CVD. The time is long overdue for the polypill to be funded for the secondary prevention of CVD.

Author Information

Vanessa Selak, Senior Lecturer, Epidemiology & Biostatistics, University of Auckland, Auckland; Bruce Arroll, Professor, General Practice and Primary Healthcare, University of Auckland, Auckland; Chris Bullen, Professor, National Institute for Health Innovation, University of Auckland, Auckland; Rob Doughty, Professor and Chair of Heart Health,
 School of Medicine, University of Auckland, Auckland; 
Corina Grey, Research Fellow, Epidemiology & Biostatistics, University of Auckland, Auckland; Matire Harwood, Associate Professor, General Practice and Primary Healthcare, University of Auckland, Auckland; Sue Crengle, Associate Professor, Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin

Acknowledgements

IMPACT trial participants; general practitioners; general practice staff; pharmacists; pharmacy staff; primary health organisations and their staff; Steering Committee; trial staff; Endpoint Adjudication Committee; Health Research Council Data Safety Monitoring Board; National Institution for Health Innovation; and funders (principally the Health Research Council and the National Heart Foundation).

Correspondence

Vanessa Selak, Epidemiology & Biostatistics, University of Auckland Private Bag 92019 Auckland 1142 Telephone +64 9 923 6509

Correspondence Email

Email v.selak@auckland.ac.nz

Competing Interests

Nil.

References

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