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POLYPILL: A DRUG TO PREVENT HEART ATTACKS?

Heart attacks and strokes are high on the list of Britain's biggest killers, with tens of thousands of lives lost each year. But it is thought that a new daily tablet, combining several low-dose drugs, could have a massive impact on prevention of these illnesses.
 

At the start of January 2011, the first trial was launched of the 'polypill' among over-50s. The idea was first put forward by two leading UK professors in 2003, with the hope of boosting Britain's fight against heart disease and strokes.

In a paper published by the British Medical Journal, professors Sir Nicholas Wald and Malcolm Law, from the Wolfson Institute of Preventative Medicine at Queen Mary, University of London, suggested that a pill combining low doses of several drugs to reduce cholesterol and blood pressure could potentially save thousands of lives each year.

They explained: "The polypill strategy could largely prevent heart attacks and strokes if taken by everyone aged 55 and older - and everyone with existing cardiovascular disease.

"It would be acceptably safe and with widespread use would have a greater impact on the prevention of disease in the western world than any other single intervention."

In response to the professors' claims, Richard Smith, then editor of the British Medical Journal, said that it was possibly "more than 50 years since we published something as important as these papers".

The idea has certainly made waves in the pharmaceutical industry, with several independent research teams now exploring possible drug combinations.

While some are examining a pill christened the "red heart", which it is hoped could cut heart disease deaths among those already known to be at risk, the Wolfson scientists have maintained their focus on the original concept.

They hope that the trial, which began on January 4th, will lay the foundations for a medicine to which anyone over the age of 50 in Britain would have affordable access from pharmacies within the next two or three years.

Dr David Wald, one of the researchers involved with the Wolfson Institute trial, said: "The polypill has the potential to be a daily preventive method against heart attacks and strokes, just as the contraceptive pill is a daily preventive method to avoid an unwanted pregnancy. This trial is a step towards making access to the polypill a reality."

The polypill is being developed by the Indian generics firm Cipla, with all of its components out of patent – and therefore cheap to obtain and use.

It contains simvastatin, which helps lower cholesterol, and three medicines in quantities half their usual dose to reduce blood pressure. Namely, the trio comprises losartan, hydrochlorothiazide and amlodipine.

But while the "red heart" contains aspirin, as it is intended for those already suffering with cardiovascular disorders, the polypill does not. Instead, it remains much closer to the treatment envisaged by Professors Wald and Law in 2003.

Because aspirin has been found in past studies to sometimes cause stomach bleeding, the Wolfson team have chosen to omit it from their trial drug – in the hope of minimising potential side-effects.
Professor Wald commented: "By offering the polypill on the basis of age alone, prevention is greatly simplified and the population receiving the polypill are not medicalised, because they do not have to become patients to receive it."

At the end of its 24-week trial, the study's 100 participants, selected on the basis of age alone, will be given the polypill for a further two years, allowing the scientists to assess its long-term benefits.

However, because the drugs used to manufacture the pill are well-tested and often prescribed together – if not included in a single tablet – there should be no reason for developers to face the usually lengthy licensing process.

Within a couple of years, the researchers are hoping it will be universally available at pharmacies across the UK.