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A single pill that combines four blood pressure and cholesterol lowering drugs along with an aspirin can reduce the risk of the nation’s No. 1 killer: heart disease.
The discovery is the result of a large new study presented Friday at the annual meeting of the American Heart Association and published simultaneously in the New England Journal of Medicine.
The more pills heart patients have to take, the less they have to comply, according to Dr. Salim Yusuf, cardiologist and lead author of the study. The reduction in the number of prescriptions to be filled “makes life easier for the doctor and the patient”, he said.
“By using existing low-cost drug combinations, we can actually make a big difference in people’s lives,” said Yusuf, professor of medicine at McMaster University in Ontario, and director of the Research Institute. on the health of the university populations.
Yusuf’s study was large, involving 5,713 people who were followed for four and a half years. The study participants were all over the age of 50 and had risk factors for heart disease, such as high blood pressure or type 2 diabetes. Most were recruited from India or the Philippines. None had a history of heart attack or stroke.
They were assigned to a placebo pill or a so-called polypill, a combination of four different drugs: three that work to lower blood pressure, and a statin for cholesterol control.
During the study period, Yusuf said polypill plus aspirin resulted in a 31% reduction in the risk of heart attack or stroke. Here’s the caveat: This translates into needing to treat 50 to 60 people to avoid any of these outcomes, Yusuf told NBC News.
But, he said, this is only the first version of a polypill to prevent cardiac events. “It’s like building your Ford Model T,” Yusuf said. “Now we have BMWs and Mercedes.”
The polypill used in the study was a combination of a statin called simvastatin, a beta blocker called atenolol, a diuretic called hydrochlorothiazide, and an ACE inhibitor called ramipril. All are sold as generics. Although such a polypill is not approved in the United States, surely doctors can prescribe them all separately.
“The advantage here is that it is an inexpensive strategy that can be widely disseminated,” said Dr. Donald Lloyd-Jones, cardiologist and president of preventive medicine at Northwestern Medicine in Chicago, during a presentation at the heart association meeting on Friday. . Lloyd-Jones was not involved in the new study.
Dr Tanja Dudenbostel, assistant professor of medicine at the University of Alabama at Birmingham, called the results “very exciting” but also said there was room for improvement. She did not participate in the new study.
Future polypills might be most useful, she said, if they come in “two or three different dose combinations.” Some doses may be better for older women, for example, while others might be better suited for young adults.
Not all cardiac experts were so quick to adopt the results.
Dr Steven Nissen, academic director of the Heart, Vascular and Thoracic Institute at the Cleveland Clinic, said that a polypill is a “terrible idea”.
“Modern medicine is about giving drugs to patients in a thoughtful way,” said Nissen. A polypill, on the other hand, “basically throws the kitchen sink at people.”
Nissen points out that all of the drugs in polypill can cause side effects. The beta-blocker atenolol can cause erectile dysfunction or impair the ability to exercise, for example. Aspirin increases the risk of bleeding.
However, the side effects noted in the new study were minimal, including dizziness or low blood pressure.
According to the Centers for Disease Control and Prevention, 655,000 Americans die from heart disease each year.
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