Publications

While the cardiovascular disease (CVD) burden has decreased in developed countries, it has exponentially increased in low- and middle-income countries (LMICs). It is estimated that by 2020, 80% of the burden of CVD will occur in LMICs (1). The decrease in developed countries has been attributed to reduction in risk factors, early detection and effective care. The increase in LMICs is largely due to rapid urbanization and poor health care systems.

The polypill, a multiconstituent combination pill containing blood pressure lowering agents, a statin, antiplatelet agent, and folic acid, was hypothesized to prevent 80% of cardiovascular events (2). Nine modifiable risk factors accounted globally for over 90% of the total population attributable risk (PAR) for an acute myocardial infarction (3) or stroke (4). Importantly, CVD risk factors are ubiquitous. In the INTERHEART study (3) conducted in 52 countries in all regions of the world, 99% of the controls had at least one CVD risk factor. To contain this global pandemic, a revolutionary strategy is called for.