'Polypill' proposed for all older persons to prevent cardiovascular disease

The researchers based their study on an awareness that lowering LDL cholesterol, homocysteine, blood pressure, and platelet function reduces the incidence of CVD. "With widespread use, [the "Polypill" strategy] would have a greater impact on the prevention of disease in the Western world than any other single intervention," they write in this weeks issue of the BMJ.Wald et al, quantified the potential efficacy and adverse effects of agents used to modify the four risk factors from published meta-analyses of randomized trials and cohort studies. The formulation which met their objectives was: a statin (for example, atorvastatin (daily dose 10 mg) or simvastatin (40 mg)); three blood pressure lowering drugs (for example, a thiazide, a b blocker, and an angiotensin converting enzyme inhibitor), each at half standard dose; folic acid (0.8 mg); and aspirin (75 mg). They estimated that their hypothetical combination (which they refer to as the Polypill) would reduce ischemic heart disease (IHD) events by 88% (95% confidence interval 84% to 91%) and stroke by 80% (71% to 87%) and maintain that one third of people taking the pill from age 55 would benefit, gaining on average about 11 years of life free from an IHD event or stroke. They add that the adverse effects of the components observed in randomised trials shows that the Polypill would cause symptoms in 8-15% of people (depending on the precise formulation). Wald et al conclude that the Polypill strategy could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing cardiovascular disease. "It would be acceptably safe and with widespread use would have a greater impact on the prevention of disease in the Western world than any other single intervention", they write. They maintain that the pill would be low cost, as it could be formulated using generic components that are not subject to patent protection. However, Dr. Robert O. Bonow, president of the American Heart Association, cast doubt on the Polypill.The problem with this 'one-size-fits-all' approach, with regard to blood pressure lowering agents and statin drugs, is that some people would be under- treated, and would not achieve the appropriate degree of blood pressure or cholesterol lowering," Dr. Bonow said in a statement. "Others who are at very low risk would have a higher likelihood of drug-related side effects over the long term, compared with any potential benefit."Drs. Wald and Law have filed a patent application on a formulation of the combined pill they described and a trademark application for the name Polypill.Reference...