At the European Society for Cardiology Congress this week, we learned about more situations where aspirin is unhelpful. Professor Gerry Fowkes and colleagues from Edinburgh looked at nearly 30000 men and women aged 50 to 80 years who had never had any cardiovascular disease, but had a low ankle-brachial pressure index, a marker of peripheral vascular disease.

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Cardiovascular disease (CVD) causes more mortality and morbidity than any other disease in both rich countries and poor countries [1]. The risk factors have been well-known for 50 years, but the optimal prevention strategy is still elusive.

Primary prevention treats individuals before they have a heart attack, whereas secondary prevention focuses on individuals who have had a heart attack. Several classes of drugs treat cardiovascular risk factors, demonstrating benefits in both primary and secondary prevention [2]. Many of these drugs are off-patent, and therefore cheap. Six years ago, Wald and Law hypothesised that a “Polypill”, containing three anti-hypertensives, folic acid, simvastatin and aspirin, could reduce the rates of CVD by over 80%, if all adults over the age of 55 years took it [3]. This week the Lancet published the first ever trial of such a Polypill [4, 5].

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