*Result*: Polypill Strategies for Cardiovascular Prevention in Older Adults: Evidence, Opportunities, and Implementation Challenges.
Title:
Polypill Strategies for Cardiovascular Prevention in Older Adults: Evidence, Opportunities, and Implementation Challenges.
Authors:
Cheikhali R; Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA., Maksymiuk V; Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA., Elattar S; Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA., Aglan A; Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA., Aronow W; Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA. Wilbert.Aronow@wmchealth.org.
Source:
Drugs & aging [Drugs Aging] 2025 Oct; Vol. 42 (10), pp. 933-943. Date of Electronic Publication: 2025 Sep 04.
Publication Type:
Journal Article; Review
Language:
English
Journal Info:
Publisher: Adis, Springer International Country of Publication: New Zealand NLM ID: 9102074 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1179-1969 (Electronic) Linking ISSN: 1170229X NLM ISO Abbreviation: Drugs Aging Subsets: MEDLINE
Imprint Name(s):
Publication: Auckland : Adis, Springer International
Original Publication: Mairangi Bay, Auckland, N.Z. : Adis International, c1991-
Original Publication: Mairangi Bay, Auckland, N.Z. : Adis International, c1991-
MeSH Terms:
References:
Khan SU, Yandrapalli S, Aronow WS, Frishman WH. Global burden of cardiovascular disease in older adults. Clin Cardiol. 2020;43(2):147–53. https://doi.org/10.1002/clc.23303 . (PMID: 10.1002/clc.23303)
Gómez-Dantés H, Fullman N, Lamadrid-Figueroa H, et al. Dissonant health transition in the states of Mexico, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2016;388(10058):2386–402. (PMID: 10.1016/S0140-6736(16)31773-127720260)
Gheorghiade M, Vaduganathan M, Fonarow GC, Bonow RO. Rehospitalization for heart failure: problems and perspectives. J Am Coll Cardiol. 2013;61(4):391–403. https://doi.org/10.1016/j.jacc.2012.09.038 . (PMID: 10.1016/j.jacc.2012.09.03823219302)
Lopez-Lopez JP, Gonzalez AM, Lanza P, Lopez-Jaramillo P. Benefits of the polypill on medication adherence in the primary and secondary prevention of cardiovascular disease: a systematic review. Vasc Health Risk Manag. 2023;19:605–15. https://doi.org/10.2147/VHRM.S421024 . (PMID: 10.2147/VHRM.S4210243771969710504901)
Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ. 2003;326(7404):1419. https://doi.org/10.1136/bmj.326.7404.1419 . (PMID: 10.1136/bmj.326.7404.141912829553162259)
Yusuf S, Pais P, Afzal R, Xavier D, Teo K, Eikelboom J, Sigamani A, Mohan V, Gupta R, Thomas N. Effects of a polypill (Polycap) on risk factors in middle-aged individuals without cardiovascular disease (TIPS): a phase II, double-blind, randomised trial. Lancet. 2009;373(9672):1341–51. https://doi.org/10.1016/S0140-6736(09)60611-5 . (PMID: 10.1016/S0140-6736(09)60611-519339045)
Roshandel G, Khoshnia M, Poustchi H, et al. Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial. Lancet. 2019;394(10199):672–83. https://doi.org/10.1016/S0140-6736(19)31791-X . (PMID: 10.1016/S0140-6736(19)31791-X31448738)
Yusuf S, Lonn E, Pais P, Bosch J, López-Jaramillo P, Zhu J, et al. Blood-pressure and cholesterol lowering in persons without cardiovascular disease. N Engl J Med. 2016;374(21):2032–43. https://doi.org/10.1056/NEJMoa1600177 . (PMID: 10.1056/NEJMoa160017727039945)
Castellano JM, Pocock SJ, Bhatt DL, et al. Polypill strategy in secondary cardiovascular prevention. N Engl J Med. 2022;387(10):967–77. https://doi.org/10.1056/NEJMoa2208275 . (PMID: 10.1056/NEJMoa220827536018037)
Thom S, Poulter N, Field J, et al. Effects of a fixed-dose combination strategy on adherence and risk factors in patients with or at high risk of CVD: the UMPIRE randomized clinical trial. JAMA. 2013;310(9):918–29. https://doi.org/10.1001/jama.2013.277064 . (PMID: 10.1001/jama.2013.27706424002278)
Patel A, Cass A, Peiris D, et al. A pragmatic randomized trial of a polypill-based strategy to improve use of indicated preventive treatments in people at high cardiovascular disease risk. Eur J Prev Cardiol. 2015;22(7):920–30. https://doi.org/10.1177/2047487314530382 . (PMID: 10.1177/204748731453038224676715)
Selak V, Elley CR, Bullen C, et al. Effect of fixed dose combination treatment on adherence and risk factor control among patients at high risk of cardiovascular disease: randomised controlled trial in primary care. BMJ. 2014;348: g3318. https://doi.org/10.1136/bmj.g3318 . (PMID: 10.1136/bmj.g331824868083)
Soliman EZ, Mendis S, Dissanayake WP, et al. A polypill for primary prevention of cardiovascular disease: a feasibility study of the World Health Organization. Trials. 2011;12:3. https://doi.org/10.1186/1745-6215-12-3 . (PMID: 10.1186/1745-6215-12-3212053253023675)
Schwalm JD, Joseph P, Leong D, et al. Cardiovascular disease in the Americas: optimizing primary and secondary prevention of cardiovascular disease series: cardiovascular disease in the Americas. Lancet Reg Health Am. 2025;42: 100964. https://doi.org/10.1016/j.lana.2024.100964 . (PMID: 10.1016/j.lana.2024.1009644003411111873640)
Joseph P, Avezum Á, Ramasundarahettige C, et al. Secondary prevention medications in 17 countries grouped by income level (PURE): a prospective cohort study. J Am Coll Cardiol. 2025;85(5):436–47. https://doi.org/10.1016/j.jacc.2024.10.121 . (PMID: 10.1016/j.jacc.2024.10.12139909677)
Singh K, Crossan C, Laba TL, et al. Cost-effectiveness of a fixed dose combination (polypill) in secondary prevention of cardiovascular diseases in India: within-trial cost-effectiveness analysis of the UMPIRE trial. Int J Cardiol. 2018;262:71–8. https://doi.org/10.1016/j.ijcard.2018.03.082 . (PMID: 10.1016/j.ijcard.2018.03.08229622506)
Gaziano TA, Pandya A, Sy S, et al. Modeling the cost effectiveness and budgetary impact of polypills for secondary prevention of cardiovascular disease in the United States. Am Heart J. 2019;214:77–87. https://doi.org/10.1016/j.ahj.2019.04.020 . (PMID: 10.1016/j.ahj.2019.04.02031174054)
World Health Organization. The Selection and Use of Essential Medicines: Report of the WHO Expert Committee, 2023 (Including the 23rd WHO Model List of Essential Medicines and the 9th WHO Model List of Essential Medicines for Children). Geneva: World Health Organization; 2023. https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2023.01 . Accessed 14 Apr 2025.
Marx N, Federici M, Schütt K, et al. 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023;44(39):4043–140. https://doi.org/10.1093/eurheartj/ehad192 . (PMID: 10.1093/eurheartj/ehad19237622663)
Sarfo FS, Ovbiagele B, Owolabi MO. Polypill programs to prevent stroke and cut costs in low income countries: moving from clinical efficacy to pragmatic implementation. Stroke. 2023;54(2):407–14. https://doi.org/10.1161/STROKEAHA.122.039567 . (PMID: 10.1161/STROKEAHA.122.039567366895929909591)
Zheng SL, Roddick AJ. Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis. JAMA. 2019;321(3):277–87. https://doi.org/10.1001/jama.2018.20578 . (PMID: 10.1001/jama.2018.20578306675016439678)
US Preventive Services Task Force. Aspirin use to prevent cardiovascular disease: US preventive services task force recommendation statement. JAMA. 2022;327(16):1577–84. https://doi.org/10.1001/jama.2022.4983 . (PMID: 10.1001/jama.2022.4983)
Okonofua EC, Simpson KN, Jesri A, Rehman SU, Durkalski VL, Egan BM. Therapeutic inertia is an impediment to achieving the Healthy People 2010 blood pressure control goals. Hypertension. 2006;47(3):345–51. https://doi.org/10.1161/01.HYP.0000200702.76436.4b . (PMID: 10.1161/01.HYP.0000200702.76436.4b16432045)
Materson BJ. Enhancing dosage flexibility in combination therapy. J Clin Hypertens (Greenwich). 2007;9(10):796–9. https://doi.org/10.1111/j.1751-7176.2007.tb00007.x . (PMID: 10.1111/j.1751-7176.2007.tb00007.x17917508)
Reid JL. Fall and rise of polypharmacy? Hypertension. 2007;49(2):266–7. https://doi.org/10.1161/01.HYP.0000254485.43156.02 . (PMID: 10.1161/01.HYP.0000254485.43156.0217178975)
Virdee SK, Greenfield SM, Fletcher K, McManus RJ, Hobbs FD, Mant J. Would primary healthcare professionals prescribe a polypill to manage cardiovascular risk? A qualitative interview study. BMJ Open. 2013;3(3): e002498. https://doi.org/10.1136/bmjopen-2012-002498 . (PMID: 10.1136/bmjopen-2012-002498235332173612792)
Satheesh G, Gyawali B, Sun MFC, et al. A survey of availability and affordability of polypills for cardiovascular disease in selected countries. Glob Heart. 2024;19(1): 56. https://doi.org/10.5334/gh.1335 . (PMID: 10.5334/gh.13353897398411225556)
Sheikh-Taha M, Asmar M. Polypharmacy and severe potential drug–drug interactions among older adults with cardiovascular disease in the United States. BMC Geriatr. 2021;21(1):233. https://doi.org/10.1186/s12877-021-02183-0 . (PMID: 10.1186/s12877-021-02183-0338274428028718)
Proietti M, Raparelli V, Olshansky B, Lip GY. Polypharmacy and major adverse events in atrial fibrillation: observations from the AFFIRM trial. Clin Res Cardiol. 2016;105(5):412–20. https://doi.org/10.1007/s00392-015-0936-y . (PMID: 10.1007/s00392-015-0936-y26525391)
Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347(23):1825–33. https://doi.org/10.1056/NEJMoa021328 . (PMID: 10.1056/NEJMoa02132812466506)
Nobili A, Licata G, Salerno F, et al. Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards: the REPOSI study. Eur J Clin Pharmacol. 2011;67(5):507–19. https://doi.org/10.1007/s00228-010-0977-0 . (PMID: 10.1007/s00228-010-0977-021221958)
Vrettos I, Voukelatou P, Katsoras A, Theotoka D, Kalliakmanis A. Diseases linked to polypharmacy in elderly patients. Curr Gerontol Geriatr Res. 2017;2017:4276047. https://doi.org/10.1155/2017/4276047 . (PMID: 10.1155/2017/4276047294346395757103)
Forman DE, Maurer MS, Boyd C, et al. Multimorbidity in older adults with cardiovascular disease. J Am Coll Cardiol. 2018;71(19):2149–61. https://doi.org/10.1016/j.jacc.2018.03.022 . (PMID: 10.1016/j.jacc.2018.03.022297478366028235)
Weiss CO, Boyd CM, Yu Q, Wolff JL, Leff B. Patterns of prevalent major chronic disease among older adults in the United States. JAMA. 2007;298(10):1160–2. https://doi.org/10.1001/jama.298.10.1160-b . (PMID: 10.1001/jama.298.10.1160-b17848649)
Aïdoud A, Gana W, Poitau F, et al. High prevalence of geriatric conditions among older adults with cardiovascular disease. J Am Heart Assoc. 2023;12(2): e026850. https://doi.org/10.1161/JAHA.122.026850 . (PMID: 10.1161/JAHA.122.026850366289629939057)
Working Group on Health Outcomes for Older Persons with Multiple Chronic Conditions. Universal health outcome measures for older persons with multiple chronic conditions. J Am Geriatr Soc. 2012;60(12):2333–41. https://doi.org/10.1111/j.1532-5415.2012.04240.x . (PMID: 10.1111/j.1532-5415.2012.04240.x3521090)
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Gómez-Dantés H, Fullman N, Lamadrid-Figueroa H, et al. Dissonant health transition in the states of Mexico, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2016;388(10058):2386–402. (PMID: 10.1016/S0140-6736(16)31773-127720260)
Gheorghiade M, Vaduganathan M, Fonarow GC, Bonow RO. Rehospitalization for heart failure: problems and perspectives. J Am Coll Cardiol. 2013;61(4):391–403. https://doi.org/10.1016/j.jacc.2012.09.038 . (PMID: 10.1016/j.jacc.2012.09.03823219302)
Lopez-Lopez JP, Gonzalez AM, Lanza P, Lopez-Jaramillo P. Benefits of the polypill on medication adherence in the primary and secondary prevention of cardiovascular disease: a systematic review. Vasc Health Risk Manag. 2023;19:605–15. https://doi.org/10.2147/VHRM.S421024 . (PMID: 10.2147/VHRM.S4210243771969710504901)
Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ. 2003;326(7404):1419. https://doi.org/10.1136/bmj.326.7404.1419 . (PMID: 10.1136/bmj.326.7404.141912829553162259)
Yusuf S, Pais P, Afzal R, Xavier D, Teo K, Eikelboom J, Sigamani A, Mohan V, Gupta R, Thomas N. Effects of a polypill (Polycap) on risk factors in middle-aged individuals without cardiovascular disease (TIPS): a phase II, double-blind, randomised trial. Lancet. 2009;373(9672):1341–51. https://doi.org/10.1016/S0140-6736(09)60611-5 . (PMID: 10.1016/S0140-6736(09)60611-519339045)
Roshandel G, Khoshnia M, Poustchi H, et al. Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial. Lancet. 2019;394(10199):672–83. https://doi.org/10.1016/S0140-6736(19)31791-X . (PMID: 10.1016/S0140-6736(19)31791-X31448738)
Yusuf S, Lonn E, Pais P, Bosch J, López-Jaramillo P, Zhu J, et al. Blood-pressure and cholesterol lowering in persons without cardiovascular disease. N Engl J Med. 2016;374(21):2032–43. https://doi.org/10.1056/NEJMoa1600177 . (PMID: 10.1056/NEJMoa160017727039945)
Castellano JM, Pocock SJ, Bhatt DL, et al. Polypill strategy in secondary cardiovascular prevention. N Engl J Med. 2022;387(10):967–77. https://doi.org/10.1056/NEJMoa2208275 . (PMID: 10.1056/NEJMoa220827536018037)
Thom S, Poulter N, Field J, et al. Effects of a fixed-dose combination strategy on adherence and risk factors in patients with or at high risk of CVD: the UMPIRE randomized clinical trial. JAMA. 2013;310(9):918–29. https://doi.org/10.1001/jama.2013.277064 . (PMID: 10.1001/jama.2013.27706424002278)
Patel A, Cass A, Peiris D, et al. A pragmatic randomized trial of a polypill-based strategy to improve use of indicated preventive treatments in people at high cardiovascular disease risk. Eur J Prev Cardiol. 2015;22(7):920–30. https://doi.org/10.1177/2047487314530382 . (PMID: 10.1177/204748731453038224676715)
Selak V, Elley CR, Bullen C, et al. Effect of fixed dose combination treatment on adherence and risk factor control among patients at high risk of cardiovascular disease: randomised controlled trial in primary care. BMJ. 2014;348: g3318. https://doi.org/10.1136/bmj.g3318 . (PMID: 10.1136/bmj.g331824868083)
Soliman EZ, Mendis S, Dissanayake WP, et al. A polypill for primary prevention of cardiovascular disease: a feasibility study of the World Health Organization. Trials. 2011;12:3. https://doi.org/10.1186/1745-6215-12-3 . (PMID: 10.1186/1745-6215-12-3212053253023675)
Schwalm JD, Joseph P, Leong D, et al. Cardiovascular disease in the Americas: optimizing primary and secondary prevention of cardiovascular disease series: cardiovascular disease in the Americas. Lancet Reg Health Am. 2025;42: 100964. https://doi.org/10.1016/j.lana.2024.100964 . (PMID: 10.1016/j.lana.2024.1009644003411111873640)
Joseph P, Avezum Á, Ramasundarahettige C, et al. Secondary prevention medications in 17 countries grouped by income level (PURE): a prospective cohort study. J Am Coll Cardiol. 2025;85(5):436–47. https://doi.org/10.1016/j.jacc.2024.10.121 . (PMID: 10.1016/j.jacc.2024.10.12139909677)
Singh K, Crossan C, Laba TL, et al. Cost-effectiveness of a fixed dose combination (polypill) in secondary prevention of cardiovascular diseases in India: within-trial cost-effectiveness analysis of the UMPIRE trial. Int J Cardiol. 2018;262:71–8. https://doi.org/10.1016/j.ijcard.2018.03.082 . (PMID: 10.1016/j.ijcard.2018.03.08229622506)
Gaziano TA, Pandya A, Sy S, et al. Modeling the cost effectiveness and budgetary impact of polypills for secondary prevention of cardiovascular disease in the United States. Am Heart J. 2019;214:77–87. https://doi.org/10.1016/j.ahj.2019.04.020 . (PMID: 10.1016/j.ahj.2019.04.02031174054)
World Health Organization. The Selection and Use of Essential Medicines: Report of the WHO Expert Committee, 2023 (Including the 23rd WHO Model List of Essential Medicines and the 9th WHO Model List of Essential Medicines for Children). Geneva: World Health Organization; 2023. https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2023.01 . Accessed 14 Apr 2025.
Marx N, Federici M, Schütt K, et al. 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023;44(39):4043–140. https://doi.org/10.1093/eurheartj/ehad192 . (PMID: 10.1093/eurheartj/ehad19237622663)
Sarfo FS, Ovbiagele B, Owolabi MO. Polypill programs to prevent stroke and cut costs in low income countries: moving from clinical efficacy to pragmatic implementation. Stroke. 2023;54(2):407–14. https://doi.org/10.1161/STROKEAHA.122.039567 . (PMID: 10.1161/STROKEAHA.122.039567366895929909591)
Zheng SL, Roddick AJ. Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis. JAMA. 2019;321(3):277–87. https://doi.org/10.1001/jama.2018.20578 . (PMID: 10.1001/jama.2018.20578306675016439678)
US Preventive Services Task Force. Aspirin use to prevent cardiovascular disease: US preventive services task force recommendation statement. JAMA. 2022;327(16):1577–84. https://doi.org/10.1001/jama.2022.4983 . (PMID: 10.1001/jama.2022.4983)
Okonofua EC, Simpson KN, Jesri A, Rehman SU, Durkalski VL, Egan BM. Therapeutic inertia is an impediment to achieving the Healthy People 2010 blood pressure control goals. Hypertension. 2006;47(3):345–51. https://doi.org/10.1161/01.HYP.0000200702.76436.4b . (PMID: 10.1161/01.HYP.0000200702.76436.4b16432045)
Materson BJ. Enhancing dosage flexibility in combination therapy. J Clin Hypertens (Greenwich). 2007;9(10):796–9. https://doi.org/10.1111/j.1751-7176.2007.tb00007.x . (PMID: 10.1111/j.1751-7176.2007.tb00007.x17917508)
Reid JL. Fall and rise of polypharmacy? Hypertension. 2007;49(2):266–7. https://doi.org/10.1161/01.HYP.0000254485.43156.02 . (PMID: 10.1161/01.HYP.0000254485.43156.0217178975)
Virdee SK, Greenfield SM, Fletcher K, McManus RJ, Hobbs FD, Mant J. Would primary healthcare professionals prescribe a polypill to manage cardiovascular risk? A qualitative interview study. BMJ Open. 2013;3(3): e002498. https://doi.org/10.1136/bmjopen-2012-002498 . (PMID: 10.1136/bmjopen-2012-002498235332173612792)
Satheesh G, Gyawali B, Sun MFC, et al. A survey of availability and affordability of polypills for cardiovascular disease in selected countries. Glob Heart. 2024;19(1): 56. https://doi.org/10.5334/gh.1335 . (PMID: 10.5334/gh.13353897398411225556)
Sheikh-Taha M, Asmar M. Polypharmacy and severe potential drug–drug interactions among older adults with cardiovascular disease in the United States. BMC Geriatr. 2021;21(1):233. https://doi.org/10.1186/s12877-021-02183-0 . (PMID: 10.1186/s12877-021-02183-0338274428028718)
Proietti M, Raparelli V, Olshansky B, Lip GY. Polypharmacy and major adverse events in atrial fibrillation: observations from the AFFIRM trial. Clin Res Cardiol. 2016;105(5):412–20. https://doi.org/10.1007/s00392-015-0936-y . (PMID: 10.1007/s00392-015-0936-y26525391)
Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347(23):1825–33. https://doi.org/10.1056/NEJMoa021328 . (PMID: 10.1056/NEJMoa02132812466506)
Nobili A, Licata G, Salerno F, et al. Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards: the REPOSI study. Eur J Clin Pharmacol. 2011;67(5):507–19. https://doi.org/10.1007/s00228-010-0977-0 . (PMID: 10.1007/s00228-010-0977-021221958)
Vrettos I, Voukelatou P, Katsoras A, Theotoka D, Kalliakmanis A. Diseases linked to polypharmacy in elderly patients. Curr Gerontol Geriatr Res. 2017;2017:4276047. https://doi.org/10.1155/2017/4276047 . (PMID: 10.1155/2017/4276047294346395757103)
Forman DE, Maurer MS, Boyd C, et al. Multimorbidity in older adults with cardiovascular disease. J Am Coll Cardiol. 2018;71(19):2149–61. https://doi.org/10.1016/j.jacc.2018.03.022 . (PMID: 10.1016/j.jacc.2018.03.022297478366028235)
Weiss CO, Boyd CM, Yu Q, Wolff JL, Leff B. Patterns of prevalent major chronic disease among older adults in the United States. JAMA. 2007;298(10):1160–2. https://doi.org/10.1001/jama.298.10.1160-b . (PMID: 10.1001/jama.298.10.1160-b17848649)
Aïdoud A, Gana W, Poitau F, et al. High prevalence of geriatric conditions among older adults with cardiovascular disease. J Am Heart Assoc. 2023;12(2): e026850. https://doi.org/10.1161/JAHA.122.026850 . (PMID: 10.1161/JAHA.122.026850366289629939057)
Working Group on Health Outcomes for Older Persons with Multiple Chronic Conditions. Universal health outcome measures for older persons with multiple chronic conditions. J Am Geriatr Soc. 2012;60(12):2333–41. https://doi.org/10.1111/j.1532-5415.2012.04240.x . (PMID: 10.1111/j.1532-5415.2012.04240.x3521090)
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Substance Nomenclature:
0 (Drug Combinations)
0 (Cardiovascular Agents)
0 (Cardiovascular Agents)
Entry Date(s):
Date Created: 20250904 Date Completed: 20250930 Latest Revision: 20250930
Update Code:
20260130
DOI:
10.1007/s40266-025-01243-z
PMID:
40906327
Database:
MEDLINE
*Further Information*
*Cardiovascular disease remains the leading cause of morbidity and mortality among older adults, who often face unique challenges in preventive care due to multimorbidity, frailty, and polypharmacy. The polypill, a fixed-dose combination of multiple cardiovascular medications, has emerged as a promising strategy to improve adherence, simplify treatment, and reduce the burden of major cardiovascular events. This review aims to synthesize current evidence supporting polypill use in both primary and secondary prevention, with a particular focus on older populations. Landmark clinical trials such as TIPS, HOPE-3, PolyIran, and SECURE have demonstrated favorable outcomes related to blood pressure and lipid reduction, medication adherence, and cardiovascular event prevention. In addition, real-world data suggest improved cost-effectiveness and feasibility across diverse healthcare settings. Despite these benefits, implementation remains limited by barriers including inflexible dosing, provider hesitancy, variable guideline endorsements, and regulatory challenges. Special considerations in geriatric populations such as heightened sensitivity to adverse drug reactions and the need for individualized care further underscores the importance of thoughtful integration into practice. As the global population ages, strategic adoption of polypill-based prevention can help address health disparities, streamline cardiovascular care, and improve outcomes in older adults worldwide.
(© 2025. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)*
*Declarations. Funding: No external funding was used in the preparation of this manuscript. Conflict of interest: Ryan Cheikhali MD, Victoria Maksymiuk MD, Sara Elattar MBBCh, Amro Aglan MD, and Wilbert Aronow MD declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript. Wilbert Aronow MD is an Editorial Board member of Drugs & Aging. Wilbert Aronow MD was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Authors’ contributions: Ryan Cheikhali MD—conceptualization, supervision, writing, reviewing and editing. Victoria Maksymiuk MD—writing. Sara Elattar MBBCh—writing. Amro Aglan MD—conceptualization, supervision, reviewing and editing. Wilbert Aronow MD—supervision. Data availability statement: Data sharing is not applicable to this article as no datasets were generated for this manuscript. Ethics approval: Not applicable. Code availability: Not applicable. Consent to participate: Not applicable. Consent for publication: Not applicable.*