Last year I wrote about a proposal by two researchers at the University of London. They proposed in 2003 that everyone who is over the age of 55 or has heart disease should take a "polypill" to lower their risk of death from a heart attack.

This polypill would contain a statin, folic acid, aspirin, and half-doses of three different blood pressure drugs (including a beta-blocker and an ACE inhibitor). It would certainly be easier and cheaper to take a single pill rather than several drugs each day.

The polypill proposal inspired a barrage of letters to the editor of the British Medical Journal, where the article was published. Most letter-writers thought the idea was dumb.

The polypill idea seemed to lie dormant until this September, when experts meeting in Spain at the World Congress of Cardiology recommended a different version of a polypill containing just three components: aspirin and off-patent versions of a statin and ACE inhibitor.

The idea was strongly supported by Valentin Fuster, president of the World Heart Federation and director of the Mount Sinai Cardiovascular Institute in New York. Fuster announced that such a polypill would be introduced in Spain in 2009 and later in the U.S.

Along with many others, I was not enthusiastic about the composition of the original polypill and the sweeping proposal that everyone over age 55 take it. I had two concerns: the danger of side effects from one of the six components of the pill, especially in people with no evidence of heart disease, and the fact that not everyone needs to lower blood pressure or cholesterol.

The new polypill is different, and the new proposal targets only people who have already had a heart attack. The newly proposed pill would contain only an ACE inhibitor rather than three antihypertensive drugs. ACE inhibitors protect against heart attacks not only by lowering blood pressure but also through other actions.

Now that we have much evidence of the benefits of achieving lower blood pressure and cholesterol levels, it may be reasonable for almost everyone who's had a heart attack to take an ACE inhibitor and a statin along with aspirin. Folic acid was dropped in the new pill, presumably because the homocysteine-lowering effect of folic acid has not been proven to prevent heart attacks.

Sidney Smith, former president of the American Heart Association, had this to say about the elements of the three-part polypill: "These therapies are known to reduce mortality by up to 50 percent or more" so that "potentially, millions of lives could be saved worldwide" by their use.