Friday, July 20, 2012


I wish to post a question to the readers. Would you take a polypill, if you are well, and just because you are 50years, to prevent cardiovascular disease? There have been many studies, looking into this issue of taking a polypill ( a pill containing many drugs ) to prevent cardiovascular disease when you grow old?
This question is prompted by the release of the most recent study, in PLoS ONE, by the group from the Wolfson Institute of Preventive Health, London. The lead author is Dr David Wald, and the co-author is Dr Nicholas wald. Wolfson Institute of Preventive Health by the way, holds the patent of the polypill for CVD prevention. They studied 86 patients who were on their preventive health program, who were all aged 50years and above, and who were free of CV disease. Half of them received the polypill and the other half, placebo, for 12 weeks. After 12 weeks, they crossover, so that each acts as their own control. The polypill tested contained amlodipine 2.5mg, losartan 25 mg, hydrochlorthiazide 12.5 mg and simvastatin 40mg. After the total of 24 weeks, the BP reduction was a mean of 12% and LDL-C reduction was a mean of 39%. These numbers are impressive. Only 2 patients dropped out of the study, so the total adherence was good. But you must bear in mind that these were people who were already on their preventive programs earlier and who may have been used to the methods and also some of the drugs.
The surprising omission is their polypill was aspirin. I suppose they were worried about GI bleeds and other bleeds. I do have serious concerns about simvastatin 40 mg which is a rather high dose to be taking without a doctors certification ( I presume that a polypill is planned so that the lay public can just buy them over the counter and take, without necessarily consulting a clinician.
I must also state that this study, is small, and this is a rather select group, who are also very good with other primary preventive measures, and so not the best group to reflect the real world.
However, the facts remain, that if a direct selling company, markets a polypill for CVD prevention, containing their drugs, will you take it. The benefits are obvious. Those numbers will translate to a 28% reduction in CVD over the long term. BUT, there are significant risk, like pill intolerance, and side effects from simvastatin 40mg, hypokalemia from HCT, hypotension from the combination of amlodipine and losartan, interactions with other incidental medication that the public may be taking. medication.
So, will you take a polypill at 50yrs, to prevent cardiovascular disease when you are 60yrs?
Give it a thought. I know of no less than 4 groups, across Canada, India, Spain and Australia actively working on a polypill, not with the same drug combination.
We await your answer and we await more clinical trial results.

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