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Risk factor modification, consisting of lifestyle measures and preventive medications, is central to preventing cardiovascular disease (CVD). One possible way to improve adherence to preventive medications is the polypill, which combines several medications in one pill. Investigators tested this strategy in a 2×2 factorial study conducted almost entirely in South Asian and Southeast Asian countries (NCT01646437). The manufacturer-supplied polypill contained simvastatin 40 mg plus three antihypertensive medications (100-mg atenolol, 25-mg hydrochlorothiazide, and 10-mg ramipril).
The 5713 participants had intermediate CV risk but no known CVD and had completed a half-dose run-in phase. They were randomized to either the daily polypill or matc…