'Polypill' Proposed for All Older
Persons to Prevent Cardiovascular Disease
A combination pill targeted at four risk
factors for cardiovascular disease (CVD) would
dramatically reduce heart attacks and strokes
by 80 percent if administered to everyone 55 or
older or with known occlusive vascular disease.
The polypill, as the scientists called it in the
British medical journal BMJ, has yet to be created.
It would contain six drugs: a cholesterol-lowering
statin; three blood-pressure medications; folic
acid, which is thought to reduce homocysteine,
a risk factor for heart disease; and aspirin,
which can prevent heart attacks.
Taking the pill would lower the risk of heart
attack by 88 percent and of stroke by 80 percent,
the scientists said. They did not estimate a cost,
but said the pill would be inexpensive because
the ingredients are generic.
Because many people stand little risk of cardiovascular
disease, the pill would not help everyone. Still,
the scientists said, a third of those taking it
would benefit, gaining an average of 11 years
free of cardiovascular disease.
"What you're trying to do with this pill
is reduce all the risk factors for cardiovascular
disease at once," said Dr. Nicholas Wald,
an epidemiologist at the University of London
who wrote the paper with Dr. Malcolm Law, another
epidemiologist at the university. "And you
want the maximum reduction that is consistent
with safety."
Eight percent to 15 percent of those who taking
the pill could be expected to suffer effects from
the ingredients, like fatigue, vivid dreams or
a cough, Dr. Wald said.
Called the “polypill,” it would contain
aspirin to reduce the stickiness of blood cells
involved in clotting, a statin drug to lower cholesterol
and folic acid to reduce levels of homocysteine,
an amino acid that promotes hardening of the arteries.
Three types of blood pressure drugs — an
ACE inhibitor, a beta-blocker and a diuretic —
would be included at half the standard dose —
enough, the doctors say, to lower blood pressure
without causing as many side effects as when the
drugs are used individually at higher doses.
The scientists based their finding on evidence
from more than 750 existing studies involving
400,000 participants taking heart medications.
By multiplying risk reductions for individual
drugs, they estimated the pill would prevent about
88 percent of heart attacks and 80 percent of
strokes if taken by people over 55, as well as
many people with high blood pressure, heart disease
or diabetes.
For example, Wald and Law calculated that if 100
people would have had a heart attack without treatment,
cholesterol drugs would prevent 61 of the 100
attacks, leaving 39. About 46 percent of those
would be prevented with blood pressure drugs,
leaving 21 heart attacks. About 16 percent of
these would be prevented with folic acid, leaving
18, and 34 percent of the remaining attacks would
be averted with aspirin, leaving 12 heart attacks
out of the original 100.
They estimated that one-third of people over 55
taking the pill would benefit, gaining on average
about 11 years of life free from a heart attack
or stroke. Side effects, mostly from aspirin,
would occur in between 8 and 15 percent of people
who take the pill, depending on the formulation,
the scientists estimated.
"The magic pill I would really like to see
is one that would motivate our patients to diet,
exercise and stop smoking," Dr. Ridker said.
"You would get far greater reductions in
heart disease than we can get from any of these
medications."
The concept, outlined Thursday on the Web site
of the British Medical Journal, is the brainchild
of two University of London doctors, Nicholas
Wald and Malcolm Law.
Studies of the “Polypill” are planned
to see if the combination is safe and effective.
Results are not expected for a few years. Law
and Wald have filed a patent application on the
formulation of the combined pill they described.
====================================================
FACT:
Statin treatment reduces major coronary events,
revascularisations, and stroke by nearly a quarter
in people with diabetes regardless of whether
they have occlusive arterial disease or raised
cholesterol. This was the finding from a major
study published last week.
Diabetic Medicine Volume 20 Issue 7 Page 545 -
July 2003
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