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Making it easy to take a pill to cure your ills

eMPR provides news to physicians and pharmacists on new drugs and new treatment strategies. The Aug. 12, 2014 issue of the Journal of the American College of Cardiology will feature an article titled Polypill Shows Potential in Global Cardiovascular Benefit.

Open heart surgery is often the solution when pills fail
Photo by David Silverman/Getty Images

Jose M. Castellano, MD, PhD from the Mount Sinai Medical Center in New York City and a group of other researchers reviewed the evidence from trials of polypills regarding the results and safety of applying polypills.

This is another meta-study that involves researching other peoples’ research. The conclusion from this study is that a polypill approach to preventing and treating cardiovascular disease (CVD) is viable. It also notes that there is a lack of evidence for its effect on reducing cardiovascular events.

Polypills combines several drugs in varying amounts into a single pill that attempts to prevent or treat a specific disease. This approach has been done for over ten years. The fact that there is a lack of evidence that a CVD polypill actually prevents heart attacks, heart disease and strokes indicates that there are other important causes that are not being addressed by a polypill for heart disease.

Polypills are an effective delivery system to reduce the number of pills that a patient is taking. This is cited as a major advantage of polypills. There are a number of drugs delivered as “cocktails” to make it easier to provide complex treatment regimens. The eMPR article provides the overall benefit statement and objectives as a CVD polypill to be sold around the world.

By reaching underdeveloped regions of the world, simplifying health care delivery, improving cost-effectiveness, increasing medication adherence, and supporting a comprehensive prescription of cardioprotective drugs, the polypill has the potential to control the global health epidemic of cardiovascular disease. Trials to examine the cost-effectiveness of reducing cardiovascular events with the polypill are currently underway.

The general public in the US has been sold on the concept of a “pill for every ill.” This allows a person to eat what they want; get minimal exercise, and handle stress with alcohol or another pill. If a major health issues happens, the doctor is expected to fix it, and the fix is often a pill. If the pills don't work, there is surgery or perhaps radiation.

The reason that Castellano and friends have not been able to find data to support a CVD polypill reducing heart attacks and strokes is because obesity, diabetes, lung disease, high blood pressure, kidney and liver disease trump a polypill approach. The CVD polypill is focused on preventing and treating heart disease. It is unlikely the polypill will be able to overcome the underlying causes for obesity, diabetes, and the other diseases mentioned above.

The National Institute of Health (NIH) has produced a study projecting the reduction in deaths from heart disease in 2020 based upon current trends. The title of the study is Quantifying options for reducing coronary heart disease mortality by 2020. The projected improvements range from 24 to 30%, if the current trends to reduce total cholesterol, systolic blood pressure, and smoking are maintained and an increase in exercise is achieved.

Conclusions: Two contrasting scenarios of change in cardiovascular health metrics could prevent 24% to 30% of the CHD deaths expected in 2020, though with differing effects by age. Unfavorable continuing trends in obesity and diabetes mellitus would have substantial adverse effects. This analysis demonstrates the utility of modelling to inform health policy.

Reading the full article in the eMPR requires a subscription. Additional summary information is available in the article. The goal of the pharmaceutical manufacturers is to provide a cardiovascular disease pill that can be sold on a global basis.

"Available clinical data support the viability of the polypill in cardiovascular disease prevention and management but with a few reservations," the authors write. "Further research of the polypill is needed, with the collective results having the potential power to change the face of health care across the world."

The increase in deaths due to heart disease around the world is following the trends in the US. As people eat more processed foods, gain weight, exercise less, develop diabetes, and smoke more, more people are dying from heart disease everywhere. Availability of a polypill for heart disease is not going to override the global trends in poor health choices.

The path to health is to follow a good diet, do regular exercise, moderate alcohol and drug use, stop smoking, and reduce stress. A polypill is not going to have the effect that this approach already provides. The attached video by a female doctor from the Mayo Clinic emphasizes these points.