Polypill: combination of three drugs helps prevent cardiovascular problems - Jornal O Sul

Polypill: combination of three drugs helps prevent cardiovascular problems – Jornal O Sul

The only medication is a combination of a blood pressure pill, a cholesterol-lowering pill and aspirin, which helps prevent blood clots. (Photo: Freepik)

Heart disease kills more people than any other condition, but despite advances in treatment and prevention, patients often do not follow their medication regimens. Now, researchers may have found a solution: the so-called polypill that combines three drugs needed to prevent cardiovascular problems.

In what appears to be the largest and longest randomized controlled trial of this approach, patients who received a polypill within six months of a heart attack were more likely to continue taking their medications and had significantly fewer cardiovascular events, compared with those who received the usual variety of pills.

The polypill combines a blood pressure medication (ramipril), a cholesterol-lowering pill (atorvastatin) and aspirin, which helps prevent blood clots. In the study, all polypills contained 100 milligrams of aspirin, but doctors could choose between three doses of ramipril and two doses of atorvastatin.

The study, carried out with more than 2,000 heart patients followed for three years, was published in The New England Journal of Medicine and presented at the Congress of the European Society of Cardiology in Barcelona.

All enrollees had survived a heart attack in the previous six months. They were over 75 years old or at least 65 years old with other health conditions, such as diabetes or kidney disease. Overall, about 80% had high blood pressure, 60% had diabetes, and more than half had a history of smoking.

Almost all patients were white and less than a third were women. The vast majority did not graduate from high school.

Participants were separated into two groups. Half received the polypill, while the other half received usual care. There were several types of polypills, and the treatment was tailored to each patient.

After six months, 70.6% of the polypill group were adhering to their regimens, compared with 62.7% of those taking the usual variety of pills. The result was even greater after two years when about three-quarters of patients were still taking the polypill, compared with 63.2% of patients taking the usual pills.

Three years later, 12.7% of patients who took a variety of pills had another heart attack, stroke, died from a cardiac event, or needed urgent treatment to open a blocked artery, compared with 9.5% of patients who took the combination of the three drugs in one.

However, there was no difference between the two groups in overall mortality, as the reduction in cardiovascular deaths in the polypill group was offset by deaths from other causes.

“People forget when there are several pills to take, they don’t take all of them or they don’t take any,” says Valentin Fuster, director of Mount Sinai Heart at Mount Sinai Hospital in New York, director general of the National Center for Cardiovascular Research in Spain and author of the study.

While polypills are already available to treat other medical conditions such as HIV and Hepatitis C, those used in the study were not approved by the US Food and Drug Administration (FDA) and are not available to patients in the US at this time. Fuster said the test results are “impressive” and that they will be presented to the agency soon in an effort to gain approval.

The polypill may be cheaper to produce and distribute than a series of different pills. The findings could help make cardiovascular prevention therapy more accessible, especially for individuals in low- and middle-income countries.

Although the cohort of patients in the European study was very homogeneous, other studies have looked at the use of polypills in minority and underserved populations.

Thomas J. Wang, chair of the department of internal medicine at UT Southwestern Medical Center led a study of a polypill prescribed for primary prevention of cardiovascular disease in a group of low-income, primarily black adults in Alabama. Adherence was very high, and participants saw greater decreases in cholesterol and blood pressure than those who received medication in their usual form.

A review of eight studies that included more than 25,000 patients, also led by Wang, found significant improvement in adherence to drug regimens with a polypill and significant reductions in cardiovascular risk factors.

“Combined pills are easier for the doctor and the patient, and the data is pretty clear – that translates to a benefit,” Wang said.

Overall mortality decreased among patients assigned to take polypills, as did serious cardiac events, particularly among those who were at low risk and had no prior heart disease.