The benefits of the polypill

Current situation 

  • There is great interest in the possible introduction of the 'polypill' to reduce cardiovascular diseases (CVD) in the UK.
  • The concept of the polypill was proposed by Professor Nicholas Wald and Professor Malcolm Law (BMJ 2003; 326: 1,419). They suggested six ingredients; a statin, aspirin, folic acid, and three antihypertensives (a thiazide, a beta blocker, and an angiotensin-converting enzyme inhibitor), all at half dose. They proposed giving the polypill as secondary prevention and also as primary prevention for all adults over 55 years.
  • The combination would prevent heart disease and stroke by reducing four risk factors: BP, lipids, homocysteine and platelet function. They calculated that CHD events would be reduced by 88 per cent and stroke by 80 per cent.

What is the evidence?

  • An analysis of the individual and combined effects of three of the polypill ingredients has provided support for the synergic action of the polypill (BMJ 2005; 330: 1,059). It found that all-cause mortality was lower in patients taking drug combinations when compared to those taking single agents.
  • The benefits of aspirin in women are less clear - a recent study found that low-dose aspirin in women did not actually produce a reduction in all-cause mortality or fatal and non-fatal MI (N Engl J Med 2005; 352: 1,293).
  • A randomised trial of folic acid was not associated with a reduction in stroke, coronary events and death in patients (JAMA 2004; 291: 565).
  • Supplements combining folic acid and vitamins B6 and B12 taken to reduce homocysteine levels did not reduce the risk of major cardiovascular events in patients with vascular disease in a recent trial (N Engl J Med 2006; 354: 1,629)
  • A recent study has shown that giving the polypill to everyone or even just those people with a moderate risk of CVD would not actually save any money at all. Giving the polypill to everyone over 60 years would actually produce the greatest health gains (J Epidemiol Community Health 2006; 60: 213).

Implications for practice

  • A series of trials would be needed before it would be possible to give the polypill to whole populations for primary prevention without screening.
  • There is some concern about 'medicalising' a healthy population by using the polypill for primary prevention (Ann Intern Med 2005; 142: 467).
  • - The concept of the polypill is thought still to be too simplistic to become a reality (Cerebrovasc Dis 2006; 21: 35)
  • There are many factors that still need to be considered regarding the risks of giving such a combination of medications to healthy people.

Useful websites

www.bhf.org.uk - British Heart Foundation

www.stroke.org.uk - The Stroke Association

- Dr Louise Newson is a GP in the West Midlands and author of 'Hot Topics for MRCGP and General Practitioners', Pas Test 2006

KEY POINTS

  • The polypill contains six drugs to prevent CHD.
  • It should not be seen as an alternative to a healthy lifestyle.
  • Further trials are needed to support the polypill in primary prevention.

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