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The Pharmaceutical Journal
Vol 270 No 7255 p881
28 June 2003

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Polypill proposed for heart disease

Researchers this week propose that everyone over the age of 55 years should take a combination of drugs in a single pill to prevent cardiovascular disease. Described as a "polypill", the proposed combination is three blood pressure lowering drugs each at half the standard dose, a statin, folic acid and aspirin (BMJ 2003;326:1419).

The polypill strategy has been outlined by Professor Nicholas Wald and Professor Malcolm Law from Barts and the London, Queen Mary's School of Medicine and Dentistry, University of London. They estimated the efficacy and adverse effects of the combination using a number of meta-analyses. Using these data, they say the polypill would reduce ischaemic heart disease (IHD) events by 88 per cent and stroke by 80 per cent.

"One third of people taking this pill from age 55 would benefit, gaining on average about 11 years of life free from an IHD event or stroke," they say. In addition to people aged over 55 years, they suggest that it is also given to everyone with known cardiovascular disease.

The polypill would cause adverse effects in between 8 and 15 per cent of people, the researchers estimate, and would be "acceptably safe". "With widespread use, [the polypill] would have a greater impact on the prevention of disease in the Western world than any other single intervention," they say.

While admitting that the strategy is radical, they comment: "It is time to discard the view that risk factors need to be measured and treated individually if found to be 'abnormal'. Instead it should be recognised that in Western Society the risk factors are high in us all, so everyone is at risk; that the diseases they cause are common and often fatal and that there is much to gain and little to lose by the wide-spread use of these drugs."

Certain issues associated with such an approach are highlighted in an accompanying editorial (ibid, p1407). These include the controversy over extensive use of preventive medicines among people without symptoms and the fact that there are other ways to reduce risk of cardiovascular disease. In addition, routine use of a polypill might prevent tailoring of medication to individuals.

Cholesterol tests at 50 Measuring the cholesterol of everyone aged 50 years and over would identify most people at high risk of developing heart disease, researchers say. They compared four screening strategies with the Framingham 10-year coronary heart disease risk equation.

A method that tailored cholesterol measurement on the basis of other known risk factors identified 99.91 per cent of people at 15 per cent or greater risk. However, this strategy required measurement of cholesterol in 73 per cent of the study population. Screening based on age required measurement of cholesterol in 46 per cent of the population and led to 93 per cent of those at 15 per cent or greater risk being identified (BMJ 2003;326:1436).