Polypill cuts risk of heart attacks by more than a third in patients aged over 50 years, study finds

A four-in-one daily pill has been found to reduce the risk of cardiovascular events by more than 30% in patients aged over 50 years, according to a five-year study published in The Lancet
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The study, published on 22 August 2019, said the polypill, which contains aspirin, atorvastatin, hydrochlorothiazide and either enalapril or valsartan, could “substantially reduce the burden of cardiovascular disease if adopted widely”.

The concept of prescribing a polypill for the prevention of cardiovascular disease (CVD) has been discussed in the pharmacy sector for more than a decade.

However, this study, conducted by researchers based in the UK, Iran, the United States, Italy and France, is the first large randomised trial of its kind.

The researchers recruited 6,838 participants in Iran aged between 50 years and 75 years for the study, which took place between May 2013 and May 2018.

Half (n=3,417) were given only lifestyle advice as a preventative measure against CVD, while the other half (n=3,421) were given the polypill in addition to lifestyle advice.

Researchers found that the medication reduced the risk of major cardiovascular events, such as heart attack, stroke and heart failure, by 34%, with 301 cardiovascular events occurring in the five-year period in the group given lifestyle advice only. This compared with 202 cardiovascular events in the group taking the polypill.

The Lancet said in a statement that the findings demonstrated for the first time the effectiveness of “a fixed-dose combination polypill containing two commonly used blood-pressure-lowering drugs, a cholesterol-lowering medicine and aspirin for both the primary and secondary prevention of CVD in the general population”.

It added that the study is the first to have a large enough sample size and follow-up time to assess the impact of the polypill on long-term fatal and non-fatal cardiovascular events in primary prevention.

“Polypills are commercially available in a number of countries for secondary prevention, but this is the largest trial confirming the value of the polypill and showing it is effective in primary prevention,” said co-author of the study Tom Marshall, professor of public health and primary care at the University of Birmingham.

“Because they have most to gain, the most efficient strategy would be to offer the polypill to those at highest risk of heart disease,” he added.

Sotiris Antoniou, consultant pharmacist in cardiovascular medicine at Barts Health NHS Trust, told The Pharmaceutical Journal that the study has contributed to “the growing support that a polypill can reduce CVD and improve adherence to therapy at a population level”.

“The polypill approach is gathering momentum to be part of a preventative programme and could improve adherence to therapy but must be complementary to ongoing lifestyle modification, such as smoking cessation and physical activity,” he said.