Should There Be a Different Cardiovascular Prevention Polypill Strategy for Women and Men?

The concept of a polypill for cardiovascular disease prevention has attracted widespread attention since Wald and Law's seminal paper in 2003. The authors estimated > 80% reduction in coronary heart disease and stroke deaths through mass application of a polypill in people aged 55 years and older. Although their proposition has been subject to criticisms and heated debate regarding side effects, efficacy, and appropriateness of the intervention, few have discussed the differential risks and benefits of a polypill for women and men and whether sex-specific polypill strategies should be developed. In this review, we discuss the benefits and drawbacks of sex-specific polypill strategies by evaluating the published literature regarding 1) sex differences in cardiovascular risk and risk reduction, 2) risks and benefits of a polypill in women compared to men, 3) anticipated hurdles to implementing a polypill strategy, 4) special considerations related to low- and middle-income country settings, and 5) potential sex-specific polypill strategies.