Cluster Randomised Trial of Polypill for Prevention of Cardiovascular Diseases in Iran: A Study Including ARC WM Collaborators
It has been over a decade since Nicholas Wald proposed combining a number of proven prophylactic therapies into a single polypill.  A team of researchers from the UK and Iran, including collaborators from ARC WM, have now tested this idea scientifically in a study with sufficient follow-up to measure effects on cardiovascular outcomes. This study is published in the Lancet. Cluster randomisation was used to avoid contamination from sharing medication.
The polypill included aspirin, a diuretic, a statin and a beta-blocker. Nearly 7,000 individuals were entered into the study from almost 240 clusters. The incidence of cardiovascular events was reduced by a third. This reduction in risk was even greater among those who had high adherence to the polypill.
This is an extremely interesting study, and has attracted considerable media interest. It is possible that the effect size in the high-income countries would have been lower, since cardiovascular risk is lower and people obtain statins and other therapy in larger numbers at baseline.
Post script. A much weaker study (based only on physiological measurements) has recently come out in the New England Journal of Medicine. Nevertheless, the findings strongly corroborate those of the Iran study in that they show a sharp reduction of risks among polypill takers.
Richard Lilford, ARC WM Director
- Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ. 2003; 326: 1419-24.
- Roshandel G, Khoshnia M, Poustchi H, et al. Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, clusterrandomised trial. Lancet. 2019; 394: 672-83.
- Muñoz D, Uzoije P, Reynolds C, et al. Polypill for Cardiovascular Disease Prevention in an Underserved Population. N Engl J Med. 2019; 381: 1114-23.