"It's perhaps more than 50 years since we published something as important"

As judged by The British Medical Journal, June 2003. The concept was formulated in 2000 by Professor Sir Nicholas Wald and Professor Malcolm Law to substantially reduce the risk of heart attacks and strokes.

How does the polypill concept work?


Taking the preventive medication provided as part of the Polypill Prevention Programme can reduce your blood pressure and cholesterol levels close to those of a 20 year old when you are 60. The Polypill Prevention Programme includes three different blood pressure reducing drugs and a statin, a medication that lowers your cholesterol.

A reduction in blood pressure at any age both reduces the risk of suffering a stroke, and reduces the risk of a heart attack. The statin included in the Polypill Prevention Programme also leads to a reduction in risk of heart disease and a reduction in risk of stroke.


Lower blood pressure and lower cholesterol to reduce your risk of heart attack and stroke


Results from 2012 randomized Polypill Crossover Trial 5

High blood pressure and high LDL cholesterol levels are the main causes of ischaemic heart disease and stroke, which are responsible for about one third of all deaths in the UK. Ischaemic heart disease and stroke are the most common causes of death worldwide.

About one in three people will, at some stage, have a heart attack or stroke unless preventive action is taken. By lowering your blood pressure and cholesterol, studies show that the Polypill Prevention Programme can reduce your risk of heart attacks and your risk of stroke by an estimated 66%.


How does it reduce my risk of heart attack and my risk of stroke?


The term polypill, coined in 2003 by Professor Sir Nicholas Wald and Professor Malcolm Law describes the medication aimed at prevention of cardiovascular disease. The term has gained widespread use and it appears in the Online Oxford Dictionary as:

A pill containing a number of medicines that all treat the same condition.

By using the right combination of medicines, a preventive medication can reduce the risk of a heart attack or stroke by two thirds. The objectives of the medicines are to reduce blood pressure and cholesterol.

What effect is there on blood pressure?


effect on blood pressure

More about blood pressure »

What effect is there on cholesterol?


effect on cholesterol

More about cholesterol »


Our 2012 randomized crossover trial

In July 2012, the results of a trial using preventive medication provided as part of the Polypill Prevention Programme, conducted at the Wolfson Institute of Preventive Medicine, were published. The trial was conducted among individuals aged 50 and over without a history of cardiovascular disease and without selection on the basis of blood pressure or cholesterol. The reductions in blood pressure and cholesterol were recorded and compared with those predicted from published estimates of the effects of the individual components.

84 participants took a preventive medication (containing amlodipine, losartan, hydrochlorothiazide and simvastatin) each evening for 12 weeks and a placebo each evening for 12 weeks in random sequence (a randomised cross-over trial).

In this trial, participants and doctors did not know whether the preventive medication or the placebo was taken during each period (double-blind). The reduction in blood pressure and cholesterol at the end of the treatment period was compared with the levels at the end of the placebo period. The allocation of the placebo or the active preventive medication was coded, and was only revealed at the end of the study. This study design provides more precise and accurate estimates of the blood pressure and cholesterol lowering effects of such preventive medication than other kinds of study. Systolic blood pressure was reduced by an average of 17.9 mmHg (12%), diastolic blood pressure by 9.8 mmHg (11%), and LDL cholesterol by 1.4 mmol/L (39%). The results were almost identical to those predicted; 18.4 mmHg, 9.7 mmHg, and 1.4 mmol/L respectively.

The trial results confirm the predicted large effect in the control of blood pressure and cholesterol made about ten years previously in the original research.

Read about our trial on PlosOne »

What medical studies have been conducted?

The basis for the polypill concept was set out in a series of three papers published in the British Medical Journal in 2003 proposing and giving evidence in support of a strategy that would reduce a person's risk of cardiovascular disease.1 The polypill strategy is intended for people above a specified age1,2,3. This is achieved by reducing blood pressure and cholesterol to levels typical of a 20 year old person.

No single intervention would have as large an effect in the prevention of heart disease and stroke.

  1. Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ 2003; 326: 1419-23
  2. Law MR, Wald NJ, Rudnick AR. Quantifying the effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ 2003; 326: 1423-7
  3. Law MR, Wald NJ, Morris JK, Jordan RE. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ 2003; 326: 1427-31
  4. Wald NJ, Simmonds M, Morris JK. Screening for Future Cardiovascular Disease Using Age Alone Compared with Multiple Risk Factors and Age. PloS ONE 2011;6(5): e18742
  5. Wald DS, Morris JK, Wald NJ. Randomized Polypill crossover trial in people aged 50 and over.PLoS One 2012;7:e41297
  6. Wald NJ, Morris JK. Quantifying the health benefits of chronic disease prevention: a fresh approach using cardiovascular disease as an example. Eur J Epidemiol 2014;29:605-612
  7. Wald NJ, Luteijn JM, Morris JK, Taylor D, Oppenheimer P. Cost-benefit analysis of the Polypill in the primary prevention of myocardial infarction and stroke.Eur J Epidemiol 2016; DOI 10.1007/s10654-016-0122-1
  8. Luteijn M, Wald NJ. The NHS Health Checks programme: a better alternative.J Med Screen 2016;23:57-58
  9. Collins R et al Interpretation of the evidence for the efficacy and safety of statin therapy. The Lancet Published online September 8, 2016
  10. Wald NJ, Luteijn J M, Morris JK. Starting the polypill: the use of a single age cut-off in males and females. J Med Screen 2017 24: 50-53

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