Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Polypills for the prevention of cardiovascular disease: a framework for wider use

Nature Medicine volume 28, pages 226–229 (2022)Cite this article

Subjects

Combinations of cardiovascular medications taken in a single pill — known as polypills — are effective but not widely used, requiring a global shift from physicians, regulators and drug developers.

Cardiovascular diseases (CVDs) are the leading cause of premature death and disability globally, with disease burden continuing to rise in low- and middle-income countries (LMICs)1. Safe and effective preventive treatments for CVDs, such as blood-pressure-lowering drugs, statins and aspirin, have been available for decades. However, most people in LMICs that are at sufficiently increased CVD risk to warrant use of these medications do not receive them2,3. Even among those at greatest risk, namely those who have survived a prior CVD event, only a small minority receive most recommended medicines and most receive no treatment whatsoever2. Similarly, for people with hypertension — which affects more than a billion people globally — most individuals do not receive any treatment, let alone the multiple drugs usually required for adequate blood pressure control4.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Timeline in the development of cardiovascular polypills.

References

  1. Roth, G. A. et al. J. Am. Coll. Cardiol. 76, 2982–3021 (2020).

    Article  Google Scholar 

  2. Yusuf, S. et al. Lancet 378, 1231–1243 (2011).

    Article  Google Scholar 

  3. Peiris, D. et al. PLoS Med. 18, e1003485 (2021).

    Article  Google Scholar 

  4. NCD Risk Factor Collaboration. Lancet 398, 957–980 (2021).

    Article  Google Scholar 

  5. Webster, R. et al. Int. J. Cardiol. 15, 147–156 (2016).

    Article  Google Scholar 

  6. Castellano, J. M. et al. J. Am. Coll. Cardiol. 64, 2071–2082 (2014).

    Article  Google Scholar 

  7. Muñoz, D. et al. N. Engl. J. Med. 381, 1114–1123 (2019).

    Article  Google Scholar 

  8. Webster, R. et al. JAMA 320, 566–579 (2018).

    Article  CAS  Google Scholar 

  9. Chow, C. K. et al. Lancet 398, 1043–1052 (2021).

    Article  Google Scholar 

  10. Lin, J. K. et al. Lancet Glob. Health 7, e1346–e1358 (2019).

    Article  Google Scholar 

  11. Lung, T. L. et al. Lancet Glob. Health 7, e1359–e1366 (2019).

    Article  Google Scholar 

  12. Gaziano, T. A. et al. Am. Heart J. 214, 77–87 (2019).

    Article  Google Scholar 

  13. Liu, H. et al. Circ. Cardiovasc. Qual. Outcomes 8, 301–308 (2015).

    Article  Google Scholar 

  14. Wood, F. et al. BMJ Open 5, e008018 (2015).

    Article  Google Scholar 

  15. Cosin-Sales, J. et al. J. Comp. Eff. Res. 10, 975–985 (2021).

    Article  Google Scholar 

  16. Wang, N. et al. Int. J. Cardiol. 341, 96–99 (2021).

    Article  Google Scholar 

  17. Roshandel, G. et al. Lancet 394, 672–683 (2019).

    Article  CAS  Google Scholar 

  18. Yusuf, S. et al. N. Engl. J. Med. 384, 216–228 (2021).

    Article  CAS  Google Scholar 

  19. Joseph, P. et al. Lancet 398, 1133–1146 (2021).

    Article  CAS  Google Scholar 

  20. Kishore, S. P. et al. J. Am. Coll. Cardiol. 71, 564–574 (2018).

    Article  Google Scholar 

  21. Khatib, R. et al. Lancet 387, 61–69 (2016).

    Article  Google Scholar 

  22. Do, N. T. et al. BMJ Glob. Health 6, e006523 (2021).

    Article  Google Scholar 

  23. Salam, A. et al. J. Clin. Hypertens. 22, 1769–1779 (2020).

    Article  Google Scholar 

  24. WHO. Guideline for the Pharmacological Treatment of Hypertension in Adults (2021).

  25. Wald, N. J. & Law, M. R. BMJ 326, 1419 (2003).

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The George Institute for Global Health, University of NSW, Sydney, NSW, Australia

    Anushka Patel, Stephen MacMahon & Anthony Rodgers

  2. Department of Medicine, University of Abuja, Abuja, Nigeria

    Dike Ojji

  3. Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka

    H. Asita de Silva

  4. School of Public Health, Imperial College London, London, UK

    Stephen MacMahon & Anthony Rodgers

Authors
  1. Anushka Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dike Ojji
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Asita de Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephen MacMahon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anthony Rodgers
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

A.P. wrote the first draft. All other authors made critical revisions.

Corresponding author

Correspondence to Anushka Patel.

Ethics declarations

Competing interests

A.P., S.M. and A.R. are employed by The George Institute for Global Health (TGI), which holds patents for ultra-low-dose-fixed combination products for the treatment of hypertension and diabetes. S.M. and A.R. are listed as inventors on these patents. S.M. is a Director on the boards of George Health Enterprises Pty Ltd (GHE) and the social enterprise arm of TGI, as well as its subsidiary George Medicines Pty Ltd (GM); these companies have received funding from public and private investors to conduct trials of fixed combination products for regulatory approval. A.R. is seconded part-time to GM. A.P., S.M. and A.R. do not have direct financial interests in any of the patent applications or investments. D.O. and H.A.d.S. declare no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Patel, A., Ojji, D., de Silva, H.A. et al. Polypills for the prevention of cardiovascular disease: a framework for wider use. Nat Med 28, 226–229 (2022). https://doi.org/10.1038/s41591-021-01635-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41591-021-01635-9

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing