A "polypill" for the primary prevention of cardiovascular disease has been 
proposed. We estimated the projected benefit of a secondary prevention 
"poly-portfolio" strategy, including pharmacologic and lifestyle approaches for 
those with coronary heart disease (CHD) or stroke. Based on recent clinical 
trial results and clinical guidelines, combinations of a high-dose statin, low 
to standard doses of antihypertensive therapy, aspirin, omega-3 fish oil, 
cardiac rehabilitation, and diet were evaluated. Patients with CHD, 
post-myocardial infarction (MI), or stroke were projected to experience 84%, 
91%, and 77% reductions, respectively, in CHD events from a pharmacologic 
approach. Numbers of those needed to treat (NNT) for 5 years were 9 to 11 to 
prevent 1 CHD event, and 21 to prevent 1 stroke. Post-MI patients were projected 
to experience a 93% reduction in the risk of CHD death (NNT 16) from a 
pharmacologic approach and a 97% reduction in the risk of CHD death (NNT 15) 
with the addition of lifestyle changes. A secondary prevention polyportfolio 
holds great promise for reducing the burden of cardiovascular disease in the 
highest risk patients.