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[Correspondence] Are ACE inhibitors acceptable ingredients in polypills?

The Lancet suggested in their Editorial (March 11, p 984)1 that an affordable polypill would be welcomed in the more than 30 million people worldwide who do not have access to appropriate secondary prevention. When considering such numbers, balance between benefits and harms becomes exceedingly important. As can be estimated by the number needed to treat, most people taking a polypill for years or decades will never be benefited by it. They nevertheless have to put up with adverse events, which are up to 16% higher (risk ratio 1·16, 95% CI 1·09–1·25) in participants randomly assigned polypills than in those assigned usual care.