Polypill shows promise for heart disease

New data presented Monday at the World Congress of Cardiology in Melbourne, Australia shows a significant improvement in both patient adherence and risk factor control when patients at high risk of heart attack or stroke receive a polypill — a fixed dose combination of commonly-used blood pressure and cholesterol lowering medications.

The Single Pill to Avert Cardiovascular Events (SPACE) project, led by researchers from The George Institute for Global Health, Australia with collaborators from other nations including South Africa, analysed data from 3140 patients with established cardiovascular disease (CVD) or at high risk of CVD.

The results showed a 43 per cent increase in patient adherence to medication at 12 months with the polypill, in addition to corresponding improvements in systolic blood pressure and LD cholesterol that were highly statistically significant.

The largest benefits were seen among patients not receiving all recommended medications at baseline, which corresponds to most cardiovascular disease patients generally.

“The results are an important step forward in the polypill journey and management of CVD,” said Ruth Webster of the George Institute for Global Health.

She adds that most patients either don’t start or don’t continue taking all the prescribed medications, which can lead to untimely death or further CVD events. Adherence in countries such as New Zealand was shown at 59 per cent and this could be much less in developing countries such as Kenya or those in Asia where still the use of proven therapies is much lower.

“An important finding from our analyses is that the greatest benefits from a polypill were for currently untreated individuals. Although the idea of a polypill has always been appealing, we now have the most comprehensive real-world analysis to date of this treatment strategy in high risk CVD patients . Given the potential affordability, even in low income countries, there is considerable potential to improve global health,” said Ruth.

Prof. Salim Yusuf, president-elect of the World Heart Federation said the results emphasize the importance of the polypill as a foundation for a global strategy on cardiovascular disease prevention.

“It will improve patient access to essential medications at an affordable cost and wide use of the polypill can avoid several millions of premature CVD,” he said.

Yusuf said the polypill may have several advantages, including improved delivery of care-in terms of procurement, storage, and distribution.

It may also avoid complex algorithms to identify individuals for therapy, increase the ease of prescribing, among other benefits.

Fixed-dose combination drugs are already widely used in hypertension and in other conditions such as AIDS and tuberculosis where it has reduced costs and improved adherence considerably.

Already, a number of South American countries including Argentina, Uruguay and Chile have joined two EU nations of Spain and Italy to approve the polypill.

Prof. Yusuf however warned that the polupill is not a replacement for a healthy lifestyle and should be combined with tobacco avoidance, a healthy diet and enhanced physical activity.

He intimated that while there is high interest on polypill by the academia, the same cannot be said of big pharma.