OBJECTIVES: To determine the combination of drugs and vitamins, and their doses, for use in a single daily pill to achieve a large effect in preventing @entity65 with minimal adverse effects. The strategy was to simultaneously reduce four cardiovascular risk factors (low density lipoprotein @entity165 , blood pressure, serum @entity1255 , and platelet function) regardless of pretreatment levels. DESIGN: We quantified the efficacy and adverse effects of the proposed formulation from published meta-analyses of randomised trials and cohort studies and a meta-analysis of 15 trials of low dose (50-125 mg/day) @entity117 . OUTCOME MEASURES: Proportional reduction in @entity299 ( @entity299 ) events and @entity64 ; life years gained; and prevalence of adverse effects. RESULTS: The formulation which met our objectives was: a statin (for example, @entity2993 (daily dose 10 mg) or @entity3413 (40 mg)); three blood pressure lowering drugs (for example, a @entity2740 , a beta blocker, and an angiotensin converting enzyme inhibitor), each at half standard dose; @entity1501 (0.8 mg); and @entity117 (75 mg). We estimate that the combination (which we call the Polypill) reduces @entity299 events by 88% (95% confidence interval 84% to 91%) and @entity64 by 80% (71% to 87%). One third of @entity1 taking this pill from age 55 would benefit, gaining on average about 11 years of life free from an @entity299 event or @entity64 . Summing the adverse effects of the components observed in randomised trials shows that the Polypill would cause symptoms in 8-15% of @entity1 (depending on the precise formulation). CONCLUSION: The Polypill strategy could largely prevent @entity299 and @entity64 if taken by everyone aged 55 and older and everyone with existing @entity65 . It would be acceptably safe and with widespread use would have a greater impact on the prevention of disease in the Western world than any other single intervention.

A strategy to reduce XXXX by more than 80%.

@entity1501 :: ('MESH:D005492', 'Chemical') :: ['folic acid'] @entity1 :: ('9606', 'Species') :: ['people'] @entity64 :: ('MESH:D020521', 'Disease') :: ['strokes', 'stroke'] @entity3413 :: ('MESH:D019821', 'Chemical') :: ['simvastatin'] @entity1255 :: ('MESH:D006710', 'Chemical') :: ['homocysteine'] @entity117 :: ('MESH:D001241', 'Chemical') :: ['aspirin'] @entity2993 :: ('MESH:C065179', 'Chemical') :: ['atorvastatin'] @entity2740 :: ('CHEBI:50264', 'Chemical') :: ['thiazide'] @entity299 :: ('MESH:D006331', 'Disease') :: ['ischaemic heart disease', 'heart attacks', 'IHD'] @entity65 :: ('MESH:D002318', 'Disease') :: ['cardiovascular disease'] @entity165 :: ('MESH:D002784', 'Chemical') :: ['cholesterol']
@entity65 :: (MESH:D002318,Disease) :: ['cardiovascular disease']
