Polypills Added to List of WHO’s Essential Medicines

The World Health Organization (WHO) has added polypills to its list of essential medications, deeming the combination cardiovascular medications a priority to meet the healthcare needs of people around the world.

On the list of essential medicines is a fixed-dose combination of aspirin, atorvastatin, and ramipril, another that includes aspirin, simvastatin, ramipril, atenolol, and hydrochlorothiazide, and a third that includes atorvastatin, perindopril, and amlodipine.

Essential medicines “are selected with due regard to disease prevalence and public health relevance, evidence of efficacy and safety, and comparative cost-effectiveness,” according to WHO. “They are intended to be available in functioning health systems at all times, in appropriate dosage forms, of assured quality, and at prices individuals and health systems can afford.”

Polypills have been proposed as a potential strategy for mitigating the risks of cardiovascular disease for more than 20 years, but this is the first time they have been included on WHO’s list of essential medications for the prevention of atherosclerotic cardiovascular disease (ASCVD). Although they are marketed as a fixed-combination tablet, different dosages of the medications are available to tailor therapy.

Last year in the New England Journal of Medicine, researchers led by Valentin Fuster, MD, PhD, published the results of the SECURE trial showing a polypill—aspirin (100 mg), ramipril (2.5, 5, or 10 mg), and atorvastatin (40 mg)—reduced the risk of major adverse cardiovascular events in patients with a prior MI. In addition to a 24% reduction in the primary endpoint of cardiovascular death, nonfatal MI, nonfatal stroke, or coronary revascularization, the risk of cardiovascular mortality with the polypill strategy was reduced by 33% compared with usual care.

Other trials have also shown the benefits of the polypill. In TIPS-3, for example, a polypill strategy that included aspirin reduced the incidence of cardiovascular events compared with placebo in intermediate-risk people without cardiovascular disease. The benefits of the fixed-dose combination strategy were also observed in PolyIran, as well as other studies showing that treatment could improve adherence and reduce ASCVD risk factors.

The WHO updates its list of essential medicines every 2 years.

Michael O’Riordan is the Associate Managing Editor for TCTMD and a Senior Journalist. He completed his undergraduate degrees at Queen’s…

World Health Organization. World Health Organization Model List of Essential Medicine, 23rd list (2023). Accessed on: August 2, 2023.

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