Evidence map›Paper›PMID 12829553›Full record

SynthesisBMJ (Clinical research ed.)2003

A strategy to reduce cardiovascular disease by more than 80%.

N J Wald, M R Law

Erratum issued 4 registry-linked trialsOpen access · bronzeAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 4 registered trials, which are not on this map. Cited by 447 papers, 16 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
447citing papers in PubMed, 16 pooled it
92.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01231165 phase2 / phase3completedstarted 2009, after this paper: background citation

Comparative Randomized Single-blind Trial of Amiloride in Coronary Heart Disease

Ran2009Enrolled70Registered outcomes3Posted comparisons0ConditionsCoronary Heart DiseaseArmsamiloride, Nitrates, clopidogrel, aspirin, statins
PMID 16195332PMID 16717147PMID 16568110PMID 15774613PMID 11854116PMID 8594927PMID 17513945PMID 17387127PMID 15491402PMID 17284700PMID 17194875other papers from this trial
Open the trial in the graph
NCT01321255 phase3completedstarted 2012, after this paper: background citation

Improving Equitable Acces and Adherence to Secondary Prevention Therapy With a Fixed-Dose Combination Drug

Ran2012Enrolled2,118Registered outcomes6Posted comparisons0ConditionsMyocardial InfarctionArmsFDC, Separately drugs, simvastatin, aspirin and ramipril
PMID 16603580PMID 17378996PMID 18288541PMID 16462975PMID 16712743PMID 16314548PMID 16338251PMID 16606817PMID 16702489PMID 16731270PMID 19482214PMID 19286092other papers from this trial
Open the trial in the graph
NCT01271985 phase3completednot on this mapstarted 2011, after this paper: background citation

Fixed-dose Combination Therapy (PolyPill) in Primary and Secondary Prevention of Cardiovascular Disease in Middle-aged and Elderly Iranians

TypeinterventionalSponsorTehran University of Medical SciencesRan2011 to 2019Enrolled8,410ConditionsCardiovascular DiseasesArmsPolyPill, Minimal care
NCT03459560 phase3unknown statusnot on this mapstarted 2015, after this paper: background citation

Effectiveness of Polypill for Primary Prevention of Cardiovascular Disease (PolyPars): Study Design and Rationale for a Pragmatic Cluster Randomized Controlled Trial

TypeinterventionalSponsorTehran University of Medical SciencesRan2015 to 2022Enrolled4,415ConditionsCardiovascular DiseasesArmsPolyPill
3 · Its place in the literature

Who cites it

447 citing papers in PubMed, 16 syntheses or guidelines pooled it, 1,567 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Guideline
  4. Pooled it
  5. Pooled it
  6. Guideline
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Pooled it
  12. Pooled it
  13. Pooled it
  14. Guideline
  15. Pooled it
  16. Fixed-dose combination therapy for the prevention of cardiovascular disease.The Cochrane database of systematic reviews · 2014
    Pooled it
  17. Trial
  18. Trial
  19. Trial
  20. Trial

387 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

2 authors at 1 institution in 1 country.

N J WaldDepartment of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and the London, Queen Mary's School of Medicine and Dentistry, University of London, London EC1M 6BQ. n.j.wald@qmul.ac.uk
M R Law
Queen Mary University of London · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo determine the combination of drugs and vitamins, and their doses, for use in a single daily pill to achieve a large effect in preventing cardiovascular disease with minimal adverse effects. The strategy was to simultaneously reduce four cardiovascular risk factors (low density lipoprotein cholesterol, blood pressure, serum homocysteine, and platelet function) regardless of pretreatment levels.

designWe 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) aspirin. OUTCOME MEASURES: Proportional reduction in ischaemic heart disease (IHD) events and strokes; life years gained; and prevalence of adverse effects.

resultsThe formulation which met our objectives was: a statin (for example, atorvastatin (daily dose 10 mg) or simvastatin (40 mg)); three blood pressure lowering drugs (for example, a thiazide, a beta blocker, and an angiotensin converting enzyme inhibitor), each at half standard dose; folic acid (0.8 mg); and aspirin (75 mg). We estimate that the combination (which we call the Polypill) reduces IHD events by 88% (95% confidence interval 84% to 91%) and stroke by 80% (71% to 87%). One third of people taking this pill from age 55 would benefit, gaining on average about 11 years of life free from an IHD event or stroke. Summing the adverse effects of the components observed in randomised trials shows that the Polypill would cause symptoms in 8-15% of people (depending on the precise formulation).

conclusionThe Polypill strategy could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing cardiovascular disease. 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.

Indexed as

Drug CombinationsAdultAgedAged, 80 and overAntihypertensive AgentsAspirinFemaleFolic AcidHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedMyocardial IschemiaPlatelet Aggregation InhibitorsRandomized Controlled Trials as TopicRisk FactorsAntihypertensive AgentsAspirinDrug CombinationsFolic AcidHydroxymethylglutaryl-CoA Reductase InhibitorsPlatelet Aggregation Inhibitors

Identifiers

PMID12829553
PMCPMC162259
OpenAlexW2163207768

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.