Combo Pill Could Prevent Heart Disease

June 26, 2003 -- A single pill with six ingredients -- aspirin, a statin, low-dose blood pressure-lowering drugs, and folic acid -- could help prevent heart disease and stroke. That's the advice from one expert who notes that lifestyle is still an issue.

The proposal appears in this week's British Medical Journal.

In making their "bold claim," researchers examined more than 750 clinical trials with 400,000 participants. They estimate that such a pill would reduce heart disease and stroke risk in people over 55 by more than 80%.

Magic Pill?

"The benefits would substantially outweigh hazards in people with [heart disease]," writes Anthony Rodgers, MD, co-director of the Clinical Trials Research Unit at the University of Auckland in New Zealand, in an editorial.

But the American Heart Association is critical. "There is no evidence that giving an entire population over the age of 55 a 'magic pill,' would significantly reduce [heart] diseases," says Robert O. Bonow, MD, AHA president, in a news release.

"Treatment with medications and with lifestyle [changes] should be tailored to an individual's specific risk factors and medical history," he adds.

The Evidence

In their analysis, British researchers looked at studies of drugs and vitamins used to reduce low-density lipoprotein (LDL) "bad" cholesterol, blood pressure, homocysteine, and clotting.

They combined the results of these interventions to determine what effect a combination pill would have on heart disease and stroke reduction, years of life gained, and adverse effects.

Their review of studies shows:

• Statins prevented 61% of heart attacks and 16% of strokes.
• Blood pressure-lowering medications prevented 46% of heart attacks and 63% of strokes.
• Folic acid prevented 16% of heart attacks and 25% of strokes.
• Aspirin prevented 32% of heart attacks and 16% of strokes.

They calculated that changing all risk factors together with a combination pill would reduce up to 88% of total heart attacks and 80% of strokes.

The "polypill" would be advised for everyone 55 and older to avoid heart attack or stroke -- especially those who already have signs of heart disease, writes lead researcher Nicholas Wald of the Wolfson Institute of Preventive Medicine in London.

About one-third of people taking the polypill would benefit, he adds. He estimates they would gain 11 to 12 years of life, on average.

More Study Needed

"The problem with this 'one-size-fits-all' approach, with regard to blood pressure-lowering agents and statin drugs, is that some people would be under-treated, and would not achieve the appropriate degree of blood pressure or cholesterol lowering," says Bonow.

"Others who are at very low risk would have a higher likelihood of drug-related side effects over the long term, compared with any potential benefit."

Trials of low-dose high blood-pressure medicine are "clearly needed before widespread use among people at moderate risk," concedes Rodgers. Nevertheless, all the drugs that the polypill would contain have remarkably few side effects, he says.

The toughest part is an old story: convincing people that heart disease is indeed a serious health problem, and that lifestyle changes are needed, Rodgers adds.

SOURCE: British Medical Journal, June 28, 2003.