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Five-in-one 'polypill' can halve risk of heart disease, says study

• Sarah Boseley, health editor
• The Guardian, Tuesday 31 March 2009
• Article history

Healthy people who take a cheap five-in-one combination "polypill" of aspirin and cholesterol and blood pressure- lowering drugs, could slash heart disease and strokes by half, the authors of a study presented yesterday say.

The polypill concept has been around for some years, but the news from the American College of Cardiology annual conference brought it closer to a reality. The combination drug, manufactured cheaply by an Indian generics company, has been tested in 412 volunteers. Others in the trial in 50 centres in India, which included more than 2,000 people, took the blood pressure and cholesterol- lowering drugs individually.

The object of this early trial, also published online by the Lancet, was to see whether the cocktail of drugs in one pill worked as well as the drugs taken separately.

The researchers found that the Polycap, as the pill has been named, reduced blood pressure and heart rate just as effectively. It also lowered cholesterol, but not quite as much as the statin it contains would have done on its own.

But the researchers, Dr Salim Yusuf of the Population Health Research Institute at McMaster University, Hamilton, Ontario in Canada, and Dr Prem Pais of St John's Medical College in Bangalore, India, and colleagues point out that there are major advantages to combining five pills in one. People who have been told they are at slight or moderate risk of a heart attack or stroke but are otherwise healthy are far more likely to take a single daily pill than a large number of different drugs.

The largest and most important target for the polypill would be the developing world, where heart attacks and strokes are soaring and a wide range of medicines are not available or are too expensive.

It would also find a market in wealthy countries, however, because of its convenience. Each year almost 200,000 Britons are killed by heart and artery disease. A fifth of all deaths before the age of 75 in men and 10% of those in women are due to cardiovascular disease.

Professor Malcolm Law, from the Wolfson Institute of Preventive Medicine in London, who was one of the pioneers of the polypill, said: "We have long advocated the polypill as a safe and effective way of greatly reducing the incidence of heart attacks and strokes in the population.

"This study shows that it's possible to make such a product that is effective and doesn't have adverse side effects."

He said a polypill such as the one used in the study would be easily affordable and greatly reduce the cost burden of doctors' appointments, blood and cholesterol tests, and treatment.

"These drugs are off-patent and cost pennies," said Law. "You might be talking in terms of 50p a day. There's no way it's going to drain resources.

"It's not going to make megabucks for anyone, but it's a public health thing."

The volunteers in the study had a relatively low risk of heart attacks and strokes. Each had at least one risk factor, such as raised blood pressure, a smoking habit or obesity. In a higher risk population, the polypill might be expected to reduce rates of heart attacks and strokes by around 75%, said Law.