The Role of a Polypill in the Primary and Secondary Prevention of Cardiovascular Disease in Low-and Medium-income Countries

Globally, non-communicable chronic diseases account for over 60% of disability-adjusted life years, 70% of deaths and more than 80% of years lived with disability. Cardiovascular diseases, including ischemic heart disease and cerebrovascular disease, contribute significantly to this burden. Despite a decline in age-standardized cardiovascular mortality rates worldwide, over 80% of cardiovascular disease deaths occur in low- and middle-income countries, leading to substantial economic losses. In these countries, cardiovascular diseases affect the working-age population more than in high-income countries, with a significant number of cardiovascular deaths occurring between the ages of 30 and 69.

Medicaments such as aspirin, statins, and antihypertensives reduce cardiovascular events. However, low medication adherence, often due to issues like availability, affordability, and challenges within the healthcare system, compromises the effectiveness of these measures. This is a widespread problem in low- and middle-income countries, necessitating alternative approaches to address these limitations.

Objective: The study aims to provide an overview of recent research on the Polypill, a combination of drugs with fixed doses designed to prevent primary and secondary cardiovascular events. The Polypill is based on the principle of increasing adherence by reducing the number of daily medications.

Methods: The latest studies and trials on Polypill treatment for preventing cardiovascular disease, including observational studies, clinical trials, and meta-analyses have been reviewed comprehensively. Case reports and editorials have been excluded. The JBI critical appraisal checklist, which scores eight items 36 for a quick visual assessment, was used to evaluate the search results.

Results: According to the WHO Multidimensional Adherence Model, researchers have found a high rate of patient acceptability for Polypill therapy compared to monotherapy in developing nations. This acceptability is associated with better outcomes, no increase of adverse effects if compared with monotherapy, and a significantly lower mean annual pharmaceutical expenditure per patient.

Overall, using the Polypill in low- and middle-income countries increases the number of years patients live and their quality of life compared to a combination of individual components.

Conclusions: Combining multiple active ingredients in a single dosage form could be a significant advancement in preventing cardiovascular conditions. However, thoroughly assessing all factors involved and creating a well-planned development strategy is crucial to increasing the likelihood of success. This study emphasizes the dual challenge posed by the global health burden of cardio- vascular disease and the barriers to effective prevention and treatment, especially in low—and middle-income countries. Addressing these challenges could substantially improve public health outcomes and reduce the economic burden of non-communicable chronic diseases.