Daily ‘polypill’ cuts risk of heart disease by up to 40%

A polypill combining four cheap cardiovascular medicines substantially reduces the risk of serious heart disease, the concept’s first large clinical trial has shown. An international team led by Tehran University of Medical Sciences in collaboration with the University of Birmingham in the UK followed 6,840 middle-aged people in north-eastern Iran over five years. Half took a daily polypill and the rest received only healthy lifestyle advice. The findings, published in The Lancet, showed 201 major cardiovascular events, notably heart attack, stroke and heart failure, among those who took the polypill and 310 in the non-using control group. Taking polypills cut the risk of such cardiovascular events by 40 per cent in people with no history of heart disease and by 20 per cent in those with previous symptoms. “The idea of the polypill has always been appealing, and now we know that a fixed-dose polypill can achieve clinical benefits in practice,” said Professor Reza Malekzadeh, project leader from the Tehran school. “The risks of side-effects from the components are very low and the potential benefits are very high.” The pills, manufactured by Alborz Darou, an Iranian pharmaceutical company, contain a statin to reduce fatty molecules in the blood, two drugs to lower blood pressure and low-dose aspirin. They cost US$0.04 each, Prof Malekzadeh told the Financial Times, and could become much cheaper if large volumes were manufactured.

The polypill was originally suggested almost 20 years ago by Professor Nicholas Wald and colleagues at the Centre for Environmental and Preventive Medicine, Queen Mary University of London. Although they have continued to promote the concept and provide polypills through a small UK company, the pharmaceutical industry and health services have not adopted the idea widely. Prof Wald was not involved in the Iran trial but welcomed its findings. “This study confirms the idea we had 19 years ago that the polypill would work for primary prevention for people without obvious disease,” he said. Statisticians at Birmingham university carried out the “cluster randomisation” process used in the trial, independently of the local Iranian study team. This determined who was and who was not to receive polypills, by allocating whole villages to be in either the experimental or control group.

News References: https://www.ft.com/content/c7a95e2c-c4e5-11e9-a8e9-296ca66511c9