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].