Polypill a Step Nearer Towards Realization

I’ve enthused over the polypill approach before. The idea is to have 4-5 medications that have proven effectiveness in reducing the risk of cardiovascular disease combined together in one pill (or capsule). A clinical trial in India was due to start in 2007, and some results have now been reported in the Lancet, and at the American College of Cardiology meeting.

The polypill used in the study contained 3 blood pressure drugs (a ‘water pill’ or thiazide, a beta-blocker, and an ACE inhibitor), a statin, and aspirin. A total of 2,053 people over 45 were enrolled at 50 Indian trial centers. They were all healthy except for having one cardiovascular risk factor – elevated blood pressure. The participants were randomly allocated to take the polypill (called Polycap®) – 412 subjects - or to one of 8 other groups of about 200 subjects each: aspirin alone, the statin (simvastatin alone), the water pill alone, 3 combinations of two blood pressure drugs, the 3 blood pressure drugs alone, or the 3 blood pressure drugs plus aspirin.

Compared with those not taking blood pressure drugs, Polycap reduced systolic pressure by an average of 7.4 mm Hg and diastolic pressure by 5.6 mm Hg over a 12-week period; these reductions were similar to those in the groups taking the 3 blood pressure drugs alone, or with aspirin.

Polycap reduced low-density lipoprotein (LDL) cholesterol by an average of 27 mEq/L (0.7 mmol/L), which was slightly less than that with the statin alone – 32 mEq/L (0.83 mmol/L); however, both reductions were greater than those for groups who received no statin. Heart rates were reduced by Polypill and the beta-blocker alone, and thromboxane measurements showed aspirin activity to be present and similar in the subjects taking aspirin.

The authors of the report conclude that Polycap could be used to “reduce multiple risk factors and cardiovascular risk”. The results support this claim. But there are some skeptics, who voiced their objections at the cardiologists’ meeting. One said: “We already have a polypill – it’s called exercise”. Point taken. There’s a risk that people on a polypill will assume it will take care of their risk from overweight and lack of activity, and become fast-food eating couch-potatoes. Another doubter thinks the side effect profile, although excellent after 12 weeks, may show problems with longer or continuous use.

Despite naysayers, I continue to believe the polypill approach may offer a solution for prevention of cardiovascular disease in parts of the world with less access to medical care than we enjoy. Further large-scale studies will show if this is so. And the costs of today’s medications may force the issue a bit for us in the more-developed societies . . .