Polypill Strategies for Cardiovascular Prevention in Older Adults: Evidence, Opportunities, and Implementation Challenges.

Cardiovascular disease remains the leading cause of morbidity and mortality among older adults, who often face unique challenges in preventive care due to multimorbidity, frailty, and polypharmacy. The polypill, a fixed-dose combination of multiple cardiovascular medications, has emerged as a promising strategy to improve adherence, simplify treatment, and reduce the burden of major cardiovascular events. This review aims to synthesize current evidence supporting polypill use in both primary and secondary prevention, with a particular focus on older populations. Landmark clinical trials such as TIPS, HOPE-3, PolyIran, and SECURE have demonstrated favorable outcomes related to blood pressure and lipid reduction, medication adherence, and cardiovascular event prevention. In addition, real-world data suggest improved cost-effectiveness and feasibility across diverse healthcare settings. Despite these benefits, implementation remains limited by barriers including inflexible dosing, provider hesitancy, variable guideline endorsements, and regulatory challenges. Special considerations in geriatric populations such as heightened sensitivity to adverse drug reactions and the need for individualized care further underscores the importance of thoughtful integration into practice. As the global population ages, strategic adoption of polypill-based prevention can help address health disparities, streamline cardiovascular care, and improve outcomes in older adults worldwide.