The Polypill in the Prevention of Cardiovascular Diseases

Abstract

Cardiovascular disease (CVD) is the major cause of death and disability globally1 and affects approximately half of all individuals over their lifetimes.2 The CVD burden has decreased in developed countries as effective prevention and treatment strategies were implemented,3,–,5 although these gains are threatened by increasing obesity, sedentary lifestyles, and diabetes mellitus.3 By contrast, CVD has increased in developing countries, and by the year 2020, 80% of the global CVD mortality is predicted to occur in low- and middle-income countries.1 The major risk factors for CVD are known. Nine to 10 potentially modifiable risk factors account for 90% of the population attributable risk for myocardial infarction and stroke, with similar estimates in all major regions of the world (Figure 1).6,7 These risk factors are ubiquitous in populations. For example, in the Framingham Study, <5% of middle-aged individuals had optimal levels of risk factors,2 in INTERHEART, 99% of control subjects had at least 1 cardiovascular risk factor,6 and in the US National Health and Nutrition Examination Surveys I, II, and III, the prevalence of low risk factor burden was only 4.4% during 1971–1975, 10.5% during 1988–1994, and 7.5% during 1999–2004.8 Figure 1. Population attributable risk for myocardial infarction associated with 7 major modifiable risk factors overall and by region in the INTERHEART study. The black bars indicate the population attributable risk associated with major biological and lifestyle risk factors combined; the blue bars indicate the population attributable risk associated with major modifiable biological risk factors (abnormal apolipoproteins, hypertension, and diabetes mellitus); and the red bars indicate the population attributable risk associated with major lifestyle modifiable risk factors (smoking, diet poor in fruits and vegetables, and lack of exercise). The 2 additional risk factors shown to significantly affect risk …