Canadian Journal of Cardiology

Increasing Appreciation for the Role of Single-Pill Combinations for the Prevention of Atherosclerotic Disease: A Pro-Polypill Polemic

  • Ross D. Feldman
    Corresponding author: Dr Ross D. Feldman, Departments of Medicine and of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, Robarts Research Institute, 100 Perth Dr, London N6A 5K8, Ontario, Canada. Tel.: +1-519-931-5717; fax: +1-519-931-5222.
    Departments of Medicine and of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
    Search for articles by this author
  • Stanley Nattel
    Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada

    Department of Pharmacology and Therapeutics, McGill University, Montréal, Québec, Canada
    Search for articles by this author
Published:March 17, 2014DOI:


      The polypill concept for atherosclerosis is based on the notion that a single pill containing multiple products that attack frequently encountered risk factors will provide important advantages as a preventive strategy, particularly in the developing world. Potential benefits include improved efficacy and greater compliance because of simplicity and reduced costs. Here, we briefly review the rationale for the polypill and the evidence supporting its value. We consider the polypill to be a major advance in combat against cardiovascular disease, with enormous benefits to global health to be expected from its use.


      Dans un contexte d'athérosclérose, le concept de polypill est basé sur la notion qu’une seule pilule, composée de multiples agents pharmacologiques, puisse cibler les facteurs de risques les plus fréquemment rencontrés. Cette approche thérapeutique apportera d’importants avantages comme stratégie préventive, particulièrement dans un monde en développement. Les bénéfices potentiels incluent des coûts réduits, une meilleure efficacité et une observance accrue de par sa simplicité d’utilisation. Dans cet article, nous discutons du concept de polypill ainsi que les preuves supportant sa validité clinique. Nous considérons que le polypill est une avancée majeure dans la lutte contre les maladies cardiovasculaires et aura d’énormes bienfaits sur la santé mondiale.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Canadian Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Wald N.J.
        • Law M.R.
        A strategy to reduce cardiovascular disease by more than 80%.
        BMJ. 2003; 326: 1419
        • Rantala A.O.
        • Kauma H.
        • Lilja M.
        • et al.
        Prevalence of the metabolic syndrome in drug-treated hypertensive patients and control subjects.
        J Intern Med. 1999; 245: 163-174
        • Ogden L.G.
        • He J.
        • Lydick E.
        • Whelton P.K.
        Long-term absolute benefit of lowering blood pressure in hypertensive patients according to the JNC VI risk stratification.
        Hypertension. 2000; 35: 539-543
        • Cushman W.C.
        • Ford C.E.
        • Einhorn P.T.
        • et al.
        Blood pressure control by drug group in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
        J Clin Hypertens (Greenwich). 2008; 10: 751-760
        • Sever P.S.
        • Dahlöf B.
        • Poulter N.R.
        • et al.
        Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial.
        Lancet. 2003; 361: 1149-1158
        • Taylor A.A.
        • Shoheiber O.
        Adherence to antihypertensive therapy with fixed-dose amlodipine besylate/benazepril HCl versus comparable component-based therapy.
        Congest Heart Fail. 2003; 9: 324-332
        • Feldman R.D.
        • Zou G.Y.
        • Vandervoort M.K.
        • et al.
        A simplified approach to the treatment of uncomplicated hypertension: a cluster randomized, controlled trial.
        Hypertension. 2009; 53: 646-653
        • Corrao G.
        • Nicotra F.
        • Parodi A.
        • et al.
        Cardiovascular protection by initial and subsequent combination of antihypertensive drugs in daily life practice.
        Hypertension. 2011; 58: 566-572
        • Jaffe M.G.
        • Lee G.A.
        • Young J.D.
        • Sidney S.
        • Go A.S.
        Improved blood pressure control associated with a large-scale hypertension program.
        JAMA. 2013; 310: 699-705
        • Spence J.D.
        A single fixed-dose combination for all patients is bad medicine.
        Can J Cardiol. 2014; 30: 513-516
        • Thom S.
        • Poulter N.
        • Field J.
        • et al.
        Effects of a fixed-dose combination strategy on adherence and risk factors in patients with or at high risk of CVD: the UMPIRE randomized clinical trial.
        JAMA. 2013; 310: 918-929
        • Castellano J.M.
        • Sanz G.
        • Fuster V.
        Evolution of the polypill concept and ongoing clinical trials.
        Can J Cardiol. 2014; 30: 520-526