A polypill containing fixed doses of four drugs reduces risk for cardiovascular events.

Nearly 7000 adults were randomized to receive either a daily polypill — comprising hydrochlorothiazide, aspirin, atorvastatin, and enalapril — plus lifestyle counseling, or lifestyle counseling alone. (Polypill recipients who developed a cough were switched to a different polypill that contained valsartan instead of enalapril.) Participants were followed for up to 5 years.

The primary outcome — incidence of major cardiovascular events — occurred significantly less often in the polypill group (5.9% vs. 8.8% of participants). The risk reduction was significant in those with and those without pre-existing cardiovascular disease. Those with high adherence saw an even greater reduction in CV events.

In an era of precision medicine, this one-size-fits-all intervention markedly reduced cardiovascular risk in a rural population. For advocates, it’s a great proof of concept; for skeptics, it feels unsatisfying, as many questions remain. It may be most appropriate for now in resource-poor settings where options are limited.

This study was published today in the Lancet.