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A healthy heart in a single pill

'Polypill' could curb heart disease and stroke.
27 June 2003

MICHAEL HOPKIN

One pill would combine existing separate drugs.
Corbis

A single pill given to everyone aged over 55 could cut heart disease in developed countries by 80%, a group of medical researchers say.

The treatment, dubbed the Polypill, would combine existing drugs to create a single medicine that would reduce the risk of heart disease and stroke. These conditions currently account for one-third of all deaths in the Western world.

"No other preventive measure would have such an impact," says Nicholas Wald of the Wolfson Institute of Preventive Medicine in London, who led the research1-3. He estimates that it would save some 200,000 lives each year in Britain alone.

Risky business

Four factors are thought to contribute to an increased risk of heart disease: blood pressure, the 'stickiness' of blood platelets, and levels of cholesterol and a chemical called homocysteine, a suspected artery blocker. If all of these can be reduced, Wald argues, the risk of heart disease will plummet.

The Polypill would contain three different drugs to reduce blood pressure, as well as aspirin to separate platelets, statin to reduce cholesterol, and folic acid to curb homocysteine levels. All of these drugs are already available separately.

Although it's an enticing idea, the Polypill should not be a licence for people to lead unhealthy lifestyles that contribute to heart disease and stroke, says Charles George, medical director of the British Heart Foundation. "The rising tide of obesity, inactivity, diabetes and continued smoking rates cannot be ignored," he argues.

The Polypill should also be rigorously tested. "As with any new treatment, it will need trials to find out just how accurate the predictions are and what side-effects occur," he says.

Proof of the pudding

First, someone will have to make the pill to see if it can bring about a simultaneous reduction in all four risk factors. So far, the team's hopes for the pill rest on combined data from more than 750 separate trials of the individual drugs.

Wald's analysis suggests that the Polypill's side-effects would be minimal. For example, three blood-pressure drugs would be included at low doses, so as to minimize their individual negative effects while still reducing blood pressure significantly.

Although the treatment could be available within two to five years, it may be difficult to find financial backing, Wald admits. All of the drugs involved are cheap and are not covered by patents. But it could nevertheless be possible to patent the Polypill's recipe.

Some experts question the ethics and economics of prescribing a single medicine to an entire section of society. But Wald argues that, in the case of heart disease, the numbers make a compelling case. "Half of us will suffer from cardiovascular disease," he says.

References
  1. Wald, N. J. & Law, M. R. A strategy to reduce heart disease by more than 80%. British Medical Journal, 326, 1419 - 1423, (2003). |Homepage|
  2. Law, M. R., Wald, N. J. & Rudnicka, A. R.Quantifying the effect of statins on low density lipoprotein cholesterol, ischaemic heart disease and stroke: systematic review and meta-analysis. British Medical Journal, 326, 1423 - 1427, (2003). |Homepage|
  3. Law, M. R., Wald, N. J., Morris, J. K & Jordan, R. E. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. British Medical Journal, 326, 1427 - 1431, (2003). |Homepage|


Nature News Service / Macmillan Magazines Ltd 2003

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