Polypill, remedy miracle or vast deception?

Reduce the leading cause of mortality by 80%! This is the incredible announcement of two British researchers. The solution is to be found in the combination of several medicines known cardiovascular disease. But after the hope, the “polypill” is today in the heart of a controversy.

The announcement of a compound able to eradicate cardiovascular disease left bode well to the discovery of a new unique compound. But in reality, the long-awaited cure could be that a clever mix of existing drugs.

Polypill

A carefully measured cocktail
Presented as the most important article published for 50 years by the prestigious British Medical Journal1, the work of researchers at the University of London Nicholas Ward and Malcolm2 Law undoubtedly constitute an event. Authors went through various studies of large magnitude (meta-analyses) and followed by population, comprising altogether 750 therapeutic trials on more 400 000 people!

Their findings could mark the history of Cardiology: they felt that increased from 55 years of a pill containing a Statin, three antihypertensives, folic acid and aspirin could reduce by over 80% the development of cardiovascular diseases. In two other articles3.4, the authors describe how they have developed their ‘miracle pill’ composition. One deals with the determination of statins and other of the hypertension. In the end, the product includes:

A Statin (e.g.atorvastatin 10 mg or simvastatin 40 mg);
Three antihypertensives (for example a thiazide, a beta blocker and an inhibitor of the enzyme conversion or IEC at the standard demi-posologie);Folic acid 0.8 mg/d;Aspirin 75 mg/d.

The actions of each of these products allow to tackle four well-established risk factors: cholesterol (LDL – C cholesterol), hypertension, homocysteine (a sulfur amino acid) and platelet function. According statistical analyses, the authors believe that taken from the age of 55, “the Polypill would reduce 88% 80 and coronary events % stroke.” One-third of the people taking this pill from the age of 55 benefit, earning on average almost 11 years no event of this type”.

All for around 8-15% adverse, is “an acceptable safety and with the wide-scale use would have more impact in the prevention of these diseases in the Western world than any other intervention”.

Prevention of a new genre?
80% Reduction in the first cause of death in Western countries! What incredible bet… but do we pack not too fast. First, this article is a statistical analysis of already published studies and in no case a survey analyzing the actual effects of the Polypill whose earnings remain theoretical. Tests the effectiveness and toxicity of this combination of products should be conducted before victory.

Another delicate point, the authors challenge several years of prevention policy. First of all, they recommend to process very large numbers of people on the sole criterion of the age: “since 96% of ischemic heart disease or stroke deaths occur in people 55 years and more, treat all people in this age group could prevent almost all of these deaths”. Authors are going to estimate that he has so “” no need to measure the four risk factors before the treatment, because such an intervention is effective regardless of their initial levels, or measure the effects of the treatment “because individual fluctuations would tend to hide effects of this product on a large scale… researchers require a real blank cheque questioning the identification of people at risk and the principle as ‘polypharmacy in doses” “fixed is inherently undesirable” as Anthony Rodgers points out in his editorial. But despite these precautions, the specialist is packaged. He added that such a pill would have for countries in developing a preventive treatment at low cost. Provided that firms rely on profits in large scale rather than by large margins.