The 50p-a-day multi-pill that could cut heart deaths by a third

A polypill to free middle-aged and elderly people from a daily cocktail of drugs could cut heart deaths by a third, research suggests.

Those prescribed the drug, which contains three medications in one, were far more likely to keep taking the tablets than those who had to take them separately, the study found.

Scientists said the cheap medication, which combines a statin with medication for blood pressure and a drug to stop clots forming, should become standard treatment for many patients.

‘Striking findings’ at congress

Researchers, said the “striking” findings presented at the European Society of Cardiology’s congress in Barcelona, should see the multi-pill, costing less than 50p a day, prescribed to those who have already suffered a heart attack.

Around four in 10 adults in the UK are currently eligible for statins, including most men over the age of 60 and women over the age of 75. Many are also on a combination of other drugs, including medication to lower blood pressure, and to stop clots forming.

While most patients who suffer a heart attack are good at taking medication in the immediate aftermath, compliance falls to less than 50 per cent for those put on a cocktail  of drugs.

The new research suggests that combining all the drugs into one pill could be far more effective in ensuring patients take their daily medication.

Study recruits 2,500 patients

In total, 2,500 patients with an average age of 76 who had previously suffered a heart attack were recruited to the study.

Half were given a polypill containing three drugs: a dose of aspirin; the blood-pressure drug ramipril; and the cholesterol-lowering drug atorvastatin. 

The other half were given usual care, which often comprises multiple separate drugs, in different doses. The participants were followed for an average of three years, and scientists monitored them for heart-related illnesses such as strokes or heart attacks.

After two years, those on the polypill were 17 per cent more likely to still be taking their medication.

Overall, the heart death rate was 33 per cent lower in the polypill group.

In total, 3.9 per cent, 48 people, of those put on the pills died from heart disease, compared with 5.8 per cent in the usual care group.  

Those put on polypills were also less likely to suffer non-fatal heart attacks and strokes.

Cheap generic medications

Polypills contain cheap generic medications, so typically cost less than 50p a day.

Dr Valentin Fuster of the Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain, and Mount Sinai Health System, New York, US, said: “The results… show, for the first time, that a polypill containing aspirin, atorvastatin, and ramipril leads to clinically relevant reductions in recurrent cardiovascular events” in patients who had suffered a heart attack.

He said the findings were particularly important because many people become less compliant in relation to advice to take multiple medications as time goes on.

Dr Fuster, principal investigator of the trial, said: “Most patients are fully adherent after an acute event but this wears off after the first six months. We wanted to have an impact early on, while all patients were adherent.”

The expert said the findings suggest that a polypill could become an “integral” part of strategies to prevent heart attacks and strokes in patients who have already suffered such events.

He said: “By simplifying treatment and improving adherence, this approach has the potential to reduce the risk of recurrent disease and cardiovascular death on a global scale.”

First heart polypill trial among the elderly

The study is the first trial to test a polypill in an elderly population who have previously had a heart attack. It involved patients from seven European countries.

Dr Fuster said he had “great hopes” the polypill will save thousands of lives around the world.

“By simplifying treatment and improving adherence, this approach has the potential to reduce the risk of recurrent disease and cardiovascular death on a global scale.”

He said: “I am excited because the problem we have in cardiovascular health is that people do not adhere [to drugs]. We know that low adherence has worse outcomes.

“Our study found the adherence to the polypill was significantly better than the pills taken separately. Use of a polypill strategy is safe, there were no differences in adverse effects.

“The results are striking. The polypill group has less heart attacks, stroke and cardiovascular death.”

The participants were all enrolled in the trial within six months of having a heart attack.

Dr Fuster said: “Most patients are fully adherent after an acute event but this wears off after the first six months. We wanted to have an impact early on, while all patients were adherent.

Controversial 2003 study

The idea of a polypill using cheap off-patent component drugs has been around since a controversial 2003 study in the British Medical Journal.

It proposed all over-55s be offered them after answering a questionnaire and the drugs would be sent out directly through the post to relieve pressure on GPs.

However, some experts feared people would simply take a pill rather than improve their lifestyle. And some in the pharmaceutical industry feared it would reduce demand for more expensive and profitable drugs.

Prof Sir Nilesh Samani, medical director at the British Heart Foundation, said: “After a heart attack, patients are prescribed several different drugs to help prevent another cardiac event.

“However, adherence to taking these tablets may decrease with time, especially if they were not prescribed any medication before.

“This study shows that combining these drugs into a single polypill may improve compliance and reduce future events, compared with taking the drugs separately. If these results are confirmed in other studies, a polypill may become the preferred way of giving these drugs to most patients after a heart attack.”

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