Cardiologist supports the heart .

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HAMILTON, Ontario — There’s good news for individuals looking for an inexpensive way to ensure a healthier heart. A “wonderpill” daily tablet containing four medicines can almost halve the risk of a heart attack or stroke and save milllions of lives, a study shows.

The cheap polypill, costing just pennies, is a cocktail of three blood pressure drugs and a lipid lowering medication. When taken with blood-thinning aspirin it cut cardiac arrests and brain hemorrhages by 40 percent. “This is the start of a transformational approach to preventing heart disease,” says in a university release. “We could save millions of people from experiencing serious heart disease or stroke each year with effective use of the polypill and aspirin.

Coronary heart disease and stroke are the top two causes of death worldwide, claiming about 18 million lives a year. More than 40 million people are impacted by cardiovascular events each year, including those who recover. Smoking, obesity and doing little exercise all increase the risk of an unhealthy heart.

“A polypill is not only effective, it is likely to be cost effective since it is based on using commonly used generic drugs,” explains co-principal investigator Prem Pais, of St John’s Medical College and Research Institute in Bangalore, India. “A polypill is convenient for patients to use as it combines several effective drugs in a single pill and is taken once a day, which would be expected to improve adherence.”

What is the polypill made of?

The study published in The New England Journal of Medicine involves 5,714 people from nine countries. Male participants were 50 or older and the women 55 or older. They were followed for an average of around four and a half years.

Participants who took the polypill alone instead of a placebo were 20 percent less likely to suffer a heart attack or stroke. Researchers say the protection double to 40 percent among those who also took an aspirin, compared to peers who received two dummy pills.

“In addition to stopping smoking, the most modifiable risk factors for cardiovascular disease are high blood pressure and elevated cholesterol. So we wanted to test a polypill along with aspirin, which has proven value in people with established vascular disease,” says Yusuf.

The polypill includes 40 mg of the cholesterol-reducing statin, simvastatin. The other drugs were 100 mg of atenolol, a beta blocker for high blood pressure, 10 mg of ramipril, also used for hypertension, and 25mg of a “water pill” or diuretic called hydrochlorothiazide. It can be combined with 75 mg of aspirin a day.

“The results of the study have implications for reducing the burden of cardiovascular diseases globally,” says Pais. “Even if only one third of eligible people receive a polypill, its use will likely avoid millions of individuals experiencing serious cardiovascular diseases worldwide. It also opens the way for a community based approach with health workers working under a physician’s supervision, enabling the pill to reach a large number of people.”

Aspirin improves outcomes in patients

The biggest benefit was seen in those who took the polypill along with aspirin. Only 4.1 percent experienced a serious cardiovascular event, compared to 5.8 percent of those who had the double placebo.

Of those who took just the polypill, 4.4 percent had a heart attack, stroke, heart surgery or died of cardiovascular problems. That’s compared to 5.5 percent who took the placebo. But this was more than twice the protection offered by aspirin, with incidence of 4.1 percent and 4.7 percent, respectively.

Of course, millions of people regularly take aspirin in the hope it will stave off a heart attack or stroke.

The polypill is already available in India and in a few countries in Africa. There are different polypills available in Europe, South America and South Korea, and new polypills are being developed in North America and China. “The use of the polypill widely will benefit people in both the rich and poor countries as there are major gaps in treatments in populations all over the world,” says second author Philip Joseph, a professor at McMaster.

Adds John Cairns, a cardiology expert and dean emeritus at the University of British Columbia: “We have recognized for a long time that primary prevention is important in cutting down heart attacks and strokes. These researchers have made a brilliant step ahead, with the factorial design testing the polypill with and without aspirin, and there is sufficient power in the study to know the results are very convincing, particularly about the use of the polypill along with aspirin.”

Story by SWNS reporter Mark Waghorn

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