Polypill and the Future of Medicine

    In 2003 in the British Medical Journal, N.J. Wald and M. R. Law introduced a proposal that they suggest could reduce all heart attacks by 88% and reduce all strokes by 80%.¹ Is this something that would interest you?  Is it something that should interest your doctors? The proposed intervention was the use of something called the "Polypill" daily by every one in the population over the age of 55 years without regard to their health or regular medications. They also recommended it for all persons at high risk of coronary artery disease regardless of their age. 
    The proposed "Polypill" consist of 6 ingredients that are already in very widespread use. Two of the ingredients are, in fact, over-the-counter products.
    The 6 elements of the Polypill are:

aspirin (1 baby aspirin, 81 mg)
folic acid (a vitamin, 0.8 mg)
a cholesterol-lowering medication known as a 'statin' (like Lipitor)
hydrochlorothiazide (or HCTZ, a diuretic, 12.5 mg)
atenolol (a beta-blocker, 25 mg)
an ACE-inhibitor (e.g., enalapril, 5 mg)

    The rationale for these agents is very strong. Aspirin is already urged by the United States Preventive Services Task Force as a routine preventive medication for the entire population (at age 40 for men, and at the time of menopause for women). Folic acid is a vitamin that is already recommended for all women of reproductive age to prevent birth defects; and about half of adult diets in the U.S. are deficient in intake. Statin medications are currently the most effective way to lower cholesterol and are already recommended for any one at high risk of heart disease. According to the 7th Report of the Joint National Commission on Hypertension approximately 50% of the entire population aged 55 years who have normal blood pressure are destined to become hypertensive. It has been understood for many years that lowering the blood pressure of the entire population by even 2-3 mm Hg would lead to a significant reduction in heart attacks. So what these authors have done is to assemble several major trends in cardiovascular health to identify the agents that could have the largest impact on outcomes, and then subject these agents (i.e., the published trials that have evaluated these agents) to rigorous analysis that led them to conclude that the benefits of each individual class of medication would be additive since they work in different ways.
    Now, mind you, they have not done an actual study of these 6 ingredients used together in actual patients. They have merely analyzed the best medical studies currently available on their use and efficacy and from these have reached their conclusions. The Polypill proposal is at this time an hypothesis, not a proven fact.

    But why do you think it is that you have never heard of it? That no one is using it? Or even talking to patients about it?  Could it be because hospitals, heart centers, cardiologists and cardiac surgeons might lose up to 80% of their business? I'm not sure. But I certainly believe this concept is important enough that everyone should be talking about it and be evaluating its potential application to their situation for themselves. Thus, as more information becomes available, I will be providing updates here of how much of this promise is likely to be realized.
    The good news is that, for the population of people already identified as at high risk for heart disease, there are some actual clinical data available which show that a combination of only 3 of the Polypill ingredients led to an 83% reduction in heart attacks and death over a period of 5 years. This is startlingly close to the number predicted in the Polypill hypothesis.
    The bottom line is that this approach to disease prevention deserves close watching in the years ahead, and we'll do that here.

    And, as a final thought, what would happen if you combined this approach with a healthy lifestyle?  Wouldn't that be something?

1.[Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ 2003; 326: 1419-24]