HEART HEALTH

One pill with many benefits

The Polypill has the potential to
reduce cardiovascular disease in
the places that need the most help

The are several barriers for patients in the healthcare system: taking time off for appointments, reliable transportation to your doctor’s office, have a working telephone number, can afford prescription medications, that you speak English, or understand your doctor’s instructions. For cardiac patients that live in remote or rural areas, these challenges seem more overwhelming when travel time or accessibility to a pharmacy or physician are considered. A low-cost, daily pill that combines four cardiac drugs known as “The Polypill” was recently tested in rural Alabama and across Iran and has shown promise to be a solution to undertreated heart patients.

What is the Polypill

Dr. Robert Benton is a board-certified cardiologist, Chief of Cardiology at Samaritan Hospital, and is the Director of Clinical Research at Capital Cardiology Associates. He broke down the Polypill on a recent episode of HeartTalk presented by Capital Cardiology Associates. “These are medicines that we know of: aspirin, a diuretic, a statin, and a blood pressure medicine. One of the questions here is, can we take medications to an at-risk population and combine low-doses of generic medications, which are inexpensive, to see if we can decrease cardiovascular outcomes? As this study in Alabama indicates, yes, yes, we can.” Just over 300 adults living in the Mobile, Alabama participated in The SCCS Polypill Pilot Trial. The trial was made up of adults 45 to 75 years of age without cardiovascular disease. 96% of participants were African-American, with an annual income under $15,000. Their blood pressure (140/83) and LDL cholesterol levels (113 mg) fell just above normal readings. Over 12 months, the study assessed medication adherence, systolic blood pressure, and LDL cholesterol. After one year, the patients on the polypill saw their blood pressure drop, on average, seven points. Their cholesterol fell by 11 points.

“This was more proof of concept trial,” added Dr. Benton. “The Alabama study was small, not an outcome study, but it does show that people who have difficulty accessing healthcare, these medicines can make a difference. We are seeing the cost-analysis of providing generic medications versus the cost of stroke or heart attack. Now we are talking about the cost of healthcare. These generic medications cost almost nothing, maybe $20 a month.” The cost of the polypill in the Alabama trial was $26 per month, although the drugs were free to study participants. Feedback from participants noted that remembering to take one pill was easier than the routine of multiple medications for blood pressure and cholesterol. “What’s really expensive is the cost of a heart attack or a stroke. That’s at least $25,000 to $50,000. We could also analyze congestive heart failure, or a pacemaker, or defibrillator expenses. The most effective thing to do is to take care of people before heart disease,” said Dr. Benton.

Reaching patients in remote areas

In another study, this a much larger trial featuring over 50,000 participants in Iran, looked at delivering drug therapy via a polypill (comprised of a statin, two drugs to lower blood pressure, and low-dose aspirin) to a large number of patients. The study was praised as a significant effort to combat a major global health problem. “What we found, in this case, was a risk reduction of about 30%,” noted Dr. Benton. The polypill in this study was effective in cutting the risk of cardiovascular events by 40% in people with no history of heart disease and by 20% in those with previous symptoms. “These aren’t new medicines,” Dr. Benton explained. “When you develop heart disease or have a cardiac event, you are going to have more than one prescription to take every day. These medications not only lower your blood pressure, cholesterol levels, or help regulate your heart rhythms, but they also decrease the likelihood of a future event. That’s the most important goal.”

Future of the Polypill

The history of the Polypill began in 1999 when Nicholas Wald, who was director of the Wolfson Institute of Preventive Medicine in London at the time, considered combining medicines to combat cardiovascular disease. Wald predicted that around 80% of heart attacks and strokes could be averted if his proposed polypill was taken by everyone aged 55 years and over, and everyone with existing CVD. The debate that followed since Wald’s idea has been over the cost, effectiveness, and practicality of using a mass-treatment approach on at-risk and low-risk populations. There are ethical, legal, and regulatory questions involved in this decision as well. For example, fixed-dose combination pills are not legal in some countries. Dr. Benton is hopeful that time will be on the side of medical science. “The polypill is not available here yet, but we have had some version of mixing a statin and a high blood pressure medication in the past. I think eventually, you will see something like this come around. I don’t think it will be a great product of major pharmaceutical companies; these are ultimately generic medicines. Most physicians will tailor a therapy that includes these medicines, just not in the form of one pill.” Research suggests that future use of a polypill will most likely be prescribed to high-risk patients or those without regular access to a family doctor to prevent future episodes.

Written by Michael Arce, Marketing Coordinator
Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional.