Treating everyone or just those at moderate risk of heart disease with the "miracle" polypill would be too much of a drain on health funds, a study says.
The "polypill" would contain a combination of heart drugs
The pill, which combines aspirin, folic acid and blood pressure and cholesterol lowering drugs, has been hailed as the magic bullet to heart-related problems.
The study of 5,000 people by Erasmus University in Holland said it had the potential to cut heart attack deaths.
But they said it should be targeted at the over 60s to be cost-effective.
The pill hass yet to be fully tested, but in theory it has the potential to slash the risk of coronary artery disease by 88% and stoke by 80 in those aged 55 to 64.
In order to estimate the potential costs of widespread polypill treatment, the researchers looked at the different levels of risk from coronary artery disease in different age groups, as well as the medical costs involved in treatment conditions such as stroke.
The data was gathered from over 5,000 people aged 28 to 62 who were monitored as part of the US Framingham Heart Study.
The researchers concluded that even if the polypill cost nothing, it would not save anything at all if given to everyone, irrespective of their risks of developing cardiovascular disease.
Even if given to those only at moderate risk no savings in terms of a reduction in the need for medical treatment would be made, they said.
But the researchers found that the largest benefits would be seen by giving the pill to everyone from the age of 60, or to those with a high risk of coronary heart disease.
They said that giving the polypill to everyone over 60 would prevent up to 179 heart attacks and up to 33 strokes per 1,000 people based on theoretical evidence on how the drug works.
But lead researcher Dr Oscar Francoduran said: "This would also imply the medicalisation of a large section of the population and the exposure of otherwise healthy subjects to unwanted adverse effects."
And he added: "The polypill seems potentially a highly effective intervention, but potential producers should be aware of the market limitations."
Judy O'Sullvan, cardiac nurse at the British Heart Foundation, said: "As the polypill is still more of a concept than reality, much remains unproven about its efficacy in reducing the global burden of heart and circulatory disease, or indeed its safety.
"Until we have the evidence from large randomised controlled trials it is premature to comment on its cost effectiveness.
"Also a polypill cannot tackle smoking, physical inactivity, diabetes or obesity - all of which significantly increase the risk of developing heart disease."
And Matt Griffiths, prescribing adviser for the Royal College of Nursing, said: "We can only assess whether a drug is worthwhile if proper research is done.
"But, as Herceptin shows, it can be hard to make decisions as patients will naturally want the best available treatment, but all drugs come with a cost and that has to be taken into account."