Taking a polypill along with aspirin may help reduce heart attacks and strokes by up to 40%, says study
As the number one killer globally, cardiovascular diseases account for nearly 18 million deaths each year. Four out of five cardiovascular disease deaths are due to heart attacks and strokes and one-third of these deaths occur prematurely in people under 70 years of age. However, a four-in-one pill that combines three blood pressure drugs and a cholesterol-lowering medication along with a polypill might be effective at reducing heart attacks, strokes and other cardiovascular events, according to researchers. They found that while the polypill alone may reduce the risk of heart attack, stroke, procedures (such as angioplasty or heart surgery) or other cardiovascular incidents by about 20%, the combination of the polypill and aspirin may reduce those cardiovascular events by up to 40%.
“This is the start of a transformational approach to preventing heart disease. We could save millions of people from experiencing serious heart disease or stroke each year with effective use of the polypill and aspirin,” writes said Salim Yusuf, a professor of medicine at McMaster University in Canada, and co-principal investigator of the report. The study, which involved people with no previous heart disease or stroke, but at intermediate risk, has been published in the New England Journal of Medicine (NEJM).
According to the authors, while the formulation of different polypills may vary, the polypill used in this study included 40 mg simvastatin, 100 mg of atenolol, 25mg of hydrochlorothiazide, and 10 mg of ramipril. It can be combined with 75 mg of aspirin a day. “The next generation of polypills will likely have greater reductions in risk factors and so can be even more effective at cutting heart disease as the formulations of polypills improve,” emphasizes Yusuf.
The analysis was conducted in 89 centers from nine countries and coordinated globally by the Population Health Research Institute (PHRI), a joint institute of McMaster University and Hamilton Health Sciences. The information came from the International Polycap Study 3 (TIPS-3) study, which followed 5,713 participants an average of 4.6 years. The men in the study were 50 or older and the women were 55 or older. They had heart disease risk factors, such as high blood pressure or Type 2 diabetes.
The experts analyzed the use of polypill alone compared to a placebo; aspirin alone versus a placebo and the polypill plus aspirin versus double placebo. “In addition to stopping smoking, the most modifiable risk factors for cardiovascular disease are high blood pressure and elevated cholesterol, so we wanted to test a polypill along with aspirin, which has proven value in people with established vascular disease,” says Yusuf, who is executive director of PHRI and a cardiologist at Hamilton Health Sciences.
The results reveal that 4.4% of those who took the polypill alone had a heart attack, stroke, a procedure, or died of cardiovascular problems compared to 5.5% who took the placebo. Of those who took just the aspirin, the incidence was 4.1% compared to 4.7% of those with the placebo. The benefits of combined polypill plus aspirin in those who continued to take the medications without interruption were larger and their use was associated with a 40% reduction in risk. Among those who took the polypill along with aspirin, 4.1% experienced a serious cardiovascular event, compared to 5.8% of those who had the double placebo.
“A polypill is not only effective, it is likely to be cost-effective since it is based on using commonly used generic drugs. A polypill is convenient for patients to use as it combines several effective drugs in a single pill and is taken once a day, which would be expected to improve adherence,” suggests Prem Pais, co-principal investigator of the study and professor at St John's Medical College and Research Institute, India.
According to Pais, the report has implications for reducing the burden of cardiovascular diseases globally. “Even if only one-third of eligible people receive a polypill, its use will likely avoid millions of individuals experiencing serious cardiovascular diseases worldwide. It also opens the way for a community-based approach with health workers working under a physician's supervision, enabling the pill to reach a large number of people,” adds Pais.