Reduce risk of heart disease with the Polypill

This paper published in the British Medical Journal ranks among my favorite, but there’s an even better sequel to it that I will review next.

The concept of a Polypill was introduced in 2003 by Wald and Law as a combination of medications and vitamins that would significantly reduce the risk of heart disease in a population.  Obviously, medications are no substitute for a healthy lifestyle, as there is inherent risk to taking any exogenous substance.  Their approach, however, was a theoretical look at combining the pharmaceutical agents and vitamins that have the best evidence for lowering cardiovascular disease risk.

They focused on the following cardiovascular risk factors:

  • Hypertension (elevated blood pressure)
  • Homocysteine
  • Platelet function

Evidence of cardiovascular disease risk reduction was based on analysis of previously published results. 

  • LDL cholesterol would be treated with a statin.
  • Hypertension would be treated with a 3-drug combination of the 5 main classes of blood pressure medications (thiazide diuretics, beta-blockers, ACE inhibitors, angiotensin II receptor blockers, and calcium channel blockers).
  • Homocysteine would be reduced with folic acid supplementation.
  • Platelet function would be addressed with aspirin.

Without going into detail about the numbers, let’s just take a look at the final analysis.  Wald and Law estimated that the cumulative risk reduction of treating all 4 of these factors by the Polypill would reduce risk of ischemic heart disease (e.g. heart attacks) by 88% and risk of stroke by 80%.

Previous studies have demonstrated that treating one risk factor has the same proportional effect (same percentage reduction) on risk irregardless of the other risk factors, so treating each risk factor does contribute an additive effect on risk reduction.

On average, they predict that this approach could result in a gain of 11-12 years of like free from heart attack or stroke for each person taking such a regimen.

Side effects from a component of this drug combination were estimated to affect 8-15% of individuals, most concerning of which would be bleeding from aspirin.

Heart disease is still the #1 cause of death in the US, and not everyone wants to take medications indefinitely to reduce their risk of heart disease.  So, who would be a candidate for this Polypill?  For individuals at relatively low risk for cardiovascular disease, there is no known significant benefit to an approach like this.  Oftentimes, the risk of side effects will outweigh benefits.  For people at high risk of heart disease, however, there may be some credence to such an approach, particularly older individuals or those with history of vascular disease.

Again, remember that this is purely a theroretical approach to reducing heart disease based on previously published studies demonstrating risk reductions of the various components of the drug combination.  In a health system that recognizes the importance of preventive medicine, this Polypill may one day become a reality.

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3 Responses to “Reduce risk of heart disease with the Polypill”

  1. In the UK it is standard practice to prescribe a statin, an ACE inhibitor or an angiotensin and aspirin to everyone who has had a heart attack. Having 3 different drugs enables the strength of each to be altered on an individual basis. The problem with a Polypill would be how the dosages of each ingredient could be changed.

    Paul

  2. I agree, Paul. Although, as a purely preventative measure, the Polypill would not necessarily demand dose adjustment.
    Combination medications are a big deal with the drug companies now – I steer clear of most of these combos for this very reason – there are too many times when I want to adjust only one component, and it becomes very expensive to a patient to do so. I do like to create simple medication regimens for patients, but the combo medication market is getting carried away.

  3. Weight Loss Pill Identifier Pills…

    I can not agree with you in 100% regarding some thoughts, but you got good point of view…

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