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A four-in-one polypill that combines three blood pressure medications with a cholesterol-lowering drug would reduce the risk of heart attack and stroke by 20-40 percent, doctors from nine countries, including Bengaluru, reported Saturday.
The polypill can be consumed alone or with aspirin with different benefits. When taken alone, it can reduce the chances of heart attack, stroke, or angioplasty by about 20%, but with aspirin those chances are reduced by 40%.
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The study involved over 5,714 patients in 89 centers in nine countries, including 39 centers in India over an eight-year period. The Indian part of the process was coordinated by St. John’s Medical College and Research Institute, Bengaluru.
“A polypill is not only effective, it is also likely to be cost-effective since it relies on the use of commonly used generic drugs,” said Prem Pais, lead co-investigator of the study and professor at St. John’s Medical College and Research Institute.
Pais said the polypill is supposed to “improve adherence” as it combines “several effective drugs into a single pill and is taken once a day.”
The multi-medical pill combines simvastatin to lower cholesterol with atenolol; hydrochlorothiazide and ramipril. It can be combined with a daily dose of aspirin.
“This result is very encouraging,” said Balram Bhargava, director general of the Indian Council of Medical Research and former professor of cardiology at the All India Institute of Medical Sciences, Delhi.
“This is another example of India’s contribution to global science. The polypill strategy deserves consideration for widespread use. Costs can be further reduced for our people if and when it enters our national programs.”
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As the most common serious disease globally, cardiovascular disease causes 18 million deaths each year, of which over 80% in low- and middle-income countries. In India, nearly 30% of all deaths and 15% of morbidity are caused by cardiovascular disease. The numbers have doubled since 1990.
“We could save millions of people from severe heart disease or stroke every year with effective use of the polypill and aspirin,” said Salim Yusuf, principal co-researcher for the study and professor of medicine at McMaster University in Canada.
Published in the New England Journal of Medicine, the study in which participants took the medicine for an average of 4.5 years showed that the benefits were maximal for those who took the medicine without interruption.
“Studies of this nature are very difficult to conduct as they involve many centers and the participants must be followed at least twice a year. In India we recruited 49% of the total sample size. This has been possible for us as we have built a collaboration for over two decades, ”said Denis Xavier, professor at St. John’s and head of the clinical research division.
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