WHF Stresses the Importance of Polypills in Global Fight Against CVD

The World Heart Federation (WHF) is once again pushing the adoption of single pill combination (SPC) drugs, also referred to as polypills, as a way to better prevent cardiovascular disease worldwide, according to a new “road map” document.

In 2023, the World Health Organization (WHO) tacked polypills onto its official list of essential medications, to the applause of many in the field of cardiovascular prevention. At the time, data from multiple studies, including SECURE, TIPS-3, and PolyIran, showed a wide range of cardiovascular benefits when patients with CVD are prescribed polypills. Since then, evidence has mounted, particularly in hypertension, with the US Food and Drug Administration approving the triple combination pill Widaplik (George Medicines) earlier this year.

“The problem is that not much is changing,” Enrico Ferro, MD (Beth Israel Deaconess Medical Center, Boston, MA), lead author of the new document, told TCTMD. “The clinical evidence is there across both primary and secondary prevention—and we described that in the road map. The cost effectiveness is there. . . . All the data is there, right? But it’s not being adopted.”

In the paper, published online in Global Heart, Ferro and colleagues review the existing evidence and highlight key barriers in the way of widespread SPC use, particularly among low- and middle-income countries. Specifically, limited manufacturing, higher cost, inconsistent recommendations, and prescriber inertia remain some of the biggest hurdles.

“Endorsement in the essential medicine list is good, and [SPCs] are endorsed [in] some countries as first line, but then they’re never in the formularies,” Ferro said. “If a pathway to reimbursement is not streamlined, then it’s hard to adopt.”

Refining the regulatory pathway would be a good step, too, as would “getting the right people to the table to talk together” about the necessity of these drugs, he said. Some of this happened at the recent European Society of Cardiology Congress 2025, where this road map was presented, but Ferro called upon international professional societies to play a bigger role in linking health care professionals with policymakers, patients, and activists to inform “procurement priorities,” especially in countries with single-payer systems.

The problem is that not much is changing. Enrico Ferro

In the US, which doesn’t have a single-payer system, Ferro still thinks it’s possible to drive greater adoption of SPCs. “If there was a way for policymakers and professional societies and so on to inform Medicare, and if Medicare were to adopt and put [polypills] as a first-line intervention given the cost-effectiveness, then private insurance would follow,” Ferro said. “It would be a more homogeneous adoption in the US.”

One thing the SPC drugs have in their favor is that there aren’t many questions left about their clinical value, he continued. Moving forward, logistical and implementation issues are yet to be worked out, something that may prove tricky to tackle considering the different variations of polypills that could be possible.

“Manufacturing is not ready to address this demand; not even half of all the possible permutations are currently manufactured,” Ferro said, adding that this should change as “personalized medicine” becomes more popular.

This year, the WHF Emerging Leaders program is committed to studying polypills to improve global cardiovascular health as well as adoption and affordability. Ferro said efforts like these are important, especially if “a handful of countries” are willing to implement SPCs into clinical practice. They could serve as case studies for future efforts that could create a snowball effect, he added.

“It’s really now all about advocating for our patients,” Ferro concluded. “The more the topic is discussed, the more awareness is raised, the more ultimately we can gather more momentum for these additional steps. That may not be the classic clinical work we’re used to doing as clinicians and researchers, but it’s equally important to make this happen.”