Professors Nicholas Wald and Malcolm Law propose that a single pill containing six active components - aspirin, a cholesterol lowering drug, three blood pressure lowering drugs at half standard dose, and folic acid - taken daily by everyone from age 55 would have a huge impact on the prevention of disease in the Western world.
Their radical strategy is based on evidence from over 750 trials involving 400,000 participants. Each component of the "Polypill" would reduce one of four cardiovascular risk factors (high blood cholesterol, blood pressure, blood homocysteine levels, and platelet function).
The pill would be suitable for people aged 55 and older and many people with existing high blood pressure, heart disease or diabetes. It need not be expensive and should be safe with minimal side effects.
Trials of the "Polypill" are planned, to see if the combination is safe and effective, and may take several years.
The authors suggest that the pill would be taken without a medical examination or measurement of risk factors as treatment would be effective whatever the initial levels of the risk factors.
It is time to discard the view that risk factors need to be measured and treated individually if found to be "abnormal," say the authors. Instead it should be recognised that in Western society the risk factors are high in all of us, so everyone is at risk. There is much to gain and little to lose by the widespread use of these drugs, they conclude.
So, is this bold conclusion justified? Quite possibly, says Dr. Anthony Rodgers in an accompanying editorial. Despite widespread perceptions, these medications are extremely safe and well tolerated – new problems seem unlikely since they have been studied so extensively and used so often together. Realising their enormous potential should be a major goal.