Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, Queen Mary University, London EC1M 6BQ, UK.
Fundam Clin Pharmacol. 2010 Feb;24(1):29-35. doi: 10.1111/j.1472-8206.2009.00795.x. Epub 2009 Nov 23.
Coronary heart disease (CHD) and stroke are the most common causes of death worldwide. The polypill, a multi-component tablet or capsule designed to reduce several cardiovascular causal risk factors simultaneously, has the potential to reduce the incidence of heart attacks and stroke by about 80%, the precise reduction depending on the formulation of the polypill and adherence to preventive treatment. The full public health impact can only be realized if the polypill is used to prevent first cardiovascular disease events, because most heart attacks and strokes are first events. A simple and effective method of selecting who should be offered the polypill is needed. Even though serum cholesterol and blood pressure are important causes of CHD and stroke and lowering them has a large preventive effect (a 1.8 mmol/L reduction in LDL cholesterol reduces the incidence of CHD events by about 60% and a 10 mmHg reduction in diastolic blood pressure also reduces the incidence of stroke by about 60%), they are poor screening tests. They add little to age in discriminating between individuals who will and will not have a CHD event or stroke. Including them in a risk assessment algorithm needlessly complicates the screening process and tends to medicalize the preventive strategy. Age alone is effective and a simpler means of selecting people for preventive treatment using the polypill.
冠心病（CHD）和中风是全球最常见的死亡原因。多效药丸是一种多成分片剂或胶囊，旨在同时降低多种心血管风险因素，它有可能将心脏病发作和中风的发生率降低约 80%，具体的降低幅度取决于多效药丸的配方和预防治疗的依从性。只有将多效药丸用于预防首次心血管疾病事件，才能充分发挥其公共卫生影响，因为大多数心脏病发作和中风都是首次事件。需要一种简单有效的方法来选择应该提供多效药丸的人群。尽管血清胆固醇和血压是冠心病和中风的重要原因，降低它们具有很大的预防效果（LDL 胆固醇降低 1.8mmol/L 可使冠心病事件的发生率降低约 60%，舒张压降低 10mmHg 也可使中风的发生率降低约 60%），但它们是较差的筛查测试。它们在区分将发生和不会发生冠心病事件或中风的个体方面，对年龄的补充作用不大。将它们纳入风险评估算法会不必要地使筛查过程复杂化，并倾向于使预防策略医学化。年龄本身就是有效的，并且是一种更简单的选择人群进行多效药丸预防治疗的方法。
