'Polypill' might prevent 80% of heart attacks, strokes

LONDON -- A single pill combining six medications could prevent more than 80 percent of heart attacks and strokes if heart patients, most diabetics and everyone over 55 took it, British scientists said.

However, the American Heart Association cautioned such a pill might be dangerous for healthy people and not strong enough for those with heart trouble. It could also lull some people into persisting with life-threatening habits.

"There are massive caveats. We are quite concerned about this," said Heart Association president Dr. Robert Bonow.

The concept is the brainchild of two University of London doctors, Nicholas Wald and Malcolm Law.

Called the "polypill," it would contain aspirin to reduce the stickiness of blood cells involved in clotting; a statin drug to lower cholesterol and folic acid to reduce levels of homocysteine, an amino acid that promotes hardening of the arteries.

Three types of blood pressure drugs -- an ACE inhibitor, a beta- blocker and a diuretic -- would be included at half the standard dose -- enough, the doctors say, to lower blood pressure without causing as many side effects as when the drugs are used individually at higher doses.

The scientists based their finding on evidence from more than 750 existing studies involving 400,000 participants taking heart medications. By multiplying risk reductions for individual drugs, they estimated the pill would prevent about 88 percent of heart attacks and 80 percent of strokes if taken by people over 55, as well as many people with high blood pressure, heart disease or diabetes.

For example, Wald and Law calculated that if 100 people would have had a heart attack without treatment, cholesterol drugs would prevent 61 of the 100 attacks, leaving 39. About 46 percent of those would be prevented with blood pressure drugs, leaving 21 heart attacks.

About 16 percent of these would be prevented with folic acid, leaving 18, and 34 percent of the remaining attacks would be averted with aspirin, leaving 12 out of the original 100.

They estimated that one-third of people over 55 taking the pill would benefit, gaining on average about 11 years of life free from a heart attack or stroke. Side effects, mostly from aspirin, would occur in between 8 and 15 percent of people who take the pill, depending on the formulation, the scientists estimated.

"The polypill represents a radical departure from current practice in the prevention of cardiovascular disease. Undoubtedly there will be debate over it, and so there should be," Wald said.

Bonow from the American Heart Association urged caution.

"There are data already on aspirin that if you give aspirin to a general population, you do not save lives because the people you save by preventing heart disease and stroke is offset by the number of people you kill by causing bleeding," he said.

While the risk of a heart attack or stroke increases after the age of 55, age alone is not a strong enough risk factor to warrant treatment, he said.

"My concern is one pill may not fit all," he said.

Dr. Eric Topol, cardiology chief at the Cleveland Clinic, said the polypill idea runs counter to the way medicine is headed in the future, which is toward personalized medication based on an individual's genetic profile.

"There is tremendous promise for the individualization of care in the years ahead," he said.

Studies of the "Polypill" are planned to see if the combination is safe and effective. Results are not expected for a few years. Law and Wald have filed a patent application on the formulation of the combined pill they described.

On the Net: British Medical Journal: www.bmj.com

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