Concept ’polypill’ to revolutionise treatment for over 55s, cutting heart attacks and strokes by more than 80%
Medical researchers conclude in this week’s BMJ that a single pill taken daily by everybody over the age of 55 would have a huge impact on the prevention of disease in the Western world, by reducing heart attacks and strokes.
Heart attacks, stroke, and other preventable cardiovascular diseases cause death or seriously affect half the population of Britain. In the latest issue of the British Medical Journal Professors Nicholas Wald and Malcolm Law claim that a single "polypill" containing six active ingredients - aspirin, a cholesterol lowering drug, three blood pressure lowering drugs at half standard dose, and folic acid - taken daily by everyone from age 55 would have "a greater impact on the prevention of disease in the Western world than any other known intervention."
Their radical prescription is based on evidence distilled from over 750 trials involving 400,000 participants. Each component of the "polypill" would reduce one of four cardiovascular risk factors: high blood cholesterol, blood pressure, blood homocysteine levels, and platelet function.
Trials of the "polypill" are planned, to see if the 6-in-1 combination is safe and effective, and that may take several years.
The authors propose the combination pill would be taken without a medical examination or any measurement of risk factors as the treatment would be effective whatever the initial levels of the risk factors.
The formulation would be suitable for people aged 55 and older as well as many people with existing high blood pressure, heart disease or diabetes. It need not be expensive and it should have minimal side effects.
It is time to discard the view that risk factors need to be measured and treated individually if found to be "abnormal," say the authors. Instead we should recognise that in Western society the risk factors are high in all of us, so everyone is at risk.
There is much to gain and little to lose by the widespread use of these drugs, they conclude.
Is this bold conclusion justified? "Quite possibly," comments Dr Anthony Rodgers in an accompanying editorial. Despite widespread perceptions, these medications are extremely safe and well tolerated. New problems seem unlikely since they have been studied so extensively and used so often together.
"Realising this enormous potential should be a major goal."
Reference
Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ 2003; 326: 1419-23.
Keywords : BMJ Heart disease risk Cardiovascular Heart attack Stroke Prevention Blood pressure Hypercholesterolaemia Platelet function Homocysteine Aspirin Statin Folic acid Thiazide diuretic Beta-blocker ACE inhibitor Calcium antagonist
