All-in-one 'polypill' could save lives, says report
Thursday 19 July 2012
An all-in-one “polypill” with the potential to save many tens of thousands of lives each year in the UK could be available in less than two years.
Results from a ground-breaking trial showed that the four-medicine pill dramatically reduces major risk factors for heart attack and stroke.
In a group of healthy individuals aged 50 and over, it cut levels of blood pressure and cholesterol to those typical of a 20-year-old.
If everyone in the UK from a similar age group took the pill, the findings suggest an estimated 100,000 to 200,000 deaths would be prevented.
The number of averted non-fatal cases, including many involving life-changing disablement, could be double this figure.
Experts called for the polypill to be made generally available to the UK population "without delay".
Realistically it could take another one to two years for all the regulatory hurdles to be overcome, according to study leader Dr David Wald, from Queen Mary, University of London.
The polypill is a layered tablet containing three blood pressure-lowering drugs and a cholesterol-lowering statin.
Dr Wald, from Queen Mary, University of London, said: "The health implications of our results are large. If people took the polypill from age 50, an estimated 28% would benefit by avoiding or delaying a heart attack or stroke during their lifetime; on average, those who benefit would gain 11 years of life without a heart attack or stroke."
The findings were published in the online journal Public Library of Science ONE.
Even before the pill was manufactured, it was predicted to have a major impact on population health.
Those forecasts have now been borne out by the first randomised study of the pill's effects on people with no history of heart disease.
A group of 84 men and women aged 50 and over were randomly given the polypill or an inactive "dummy" tablet for a period of three months.
They then switched treatments for another three months so the effects of both were seen in each patient.
Taking the polypill led to a 12% lowering of blood pressure, and a 39% reduction in levels of "bad" cholesterol, or low-density lipoprotein (LDL).
The cost of the prescription-only pill is expected to be no more than a few hundred pounds a year.
Dr Wald said: "With the results of this trial we do have a pretty firm platform to move to the next stage to make it available and accessible, so when people hit a certain age they can choose if it's something they want or not.
"When something like this is developed it should be made available as quickly as possible. How people pay for it is a judgment society needs to make."
He predicted that between 100,000 and 200,000 deaths - and twice as many non-fatal events - could be prevented if everyone in the UK over the age of 50 took the pill.
His father, Professor Sir Nicholas Wald, the pill's inventor, had a more conservative estimate but still envisioned many thousands of lives being saved.
Sir Nicholas, director of the Wolfson Institute of Preventive Medicine at Queen Mary, said: "We now need public, professional and regulatory support to make the polypill available without delay. The net benefits are too large to ignore.
"Even if only 50% of people aged 50 or more took the polypill, about 94,000 fatal and non-fatal heart attacks and strokes would be prevented each year in the UK."
One of the trial participants was David Taylor, Professor of Pharmaceutical and Public Health Policy at University College London, who joined the calls for general access to the polypill.
"The polypill concept is a major public health advance," he said. "This study shows that it works. The polypill should be made generally available as a matter of urgency.
"I welcome the opportunity to substantially cut my risk of having a stroke or heart attack without the disempowering fuss and bother usually required to obtain preventive medicines."
However, the British Heart Foundation sounded a note of caution.
Natasha Stewart, senior cardiac nurse at the charity, said: "Research into polypills is encouraging, but there are still many questions to answer before this 'wonder drug' is prescribed by doctors.
"This research only studied a very small number of people, so we'd need to see further large-scale trials on a wider population to get more detailed results. It is also hard to say if the near-perfect adherence rate for taking the pills would be seen in real life.
"However interesting this potential new pill is, medicines are not a substitute for living a healthy lifestyle. Staying active, eating healthily and not smoking are still vital ways to help keep your heart in good shape."
The polypill used in the study contained the blood pressure drugs amlodipine, losartan and hydrochlorothiazide together with cholesterol-lowering simvastatin.
Results from an international trial of a similar polypill containing aspirin as well as blood pressure and cholesterol-reducing drugs were reported last year.
That study involved 378 people with an increased risk of heart disease, rather than average members of the public. The results suggested that long-term use of the pill could halve rates of heart disease and stroke.
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