Pretty Poly

About ten years ago, the medical world was startled when a paper appeared proposing the combining of several medications in a so-called “polypill” to prevent cardiovascular disease.  The medications were aspirin, statin, ACE inhibitor and a diuretic.

Initially, some people thought that the proposal was a joke but then others began to see a certain logic in the idea.  So what’s afoot ?

The arguments in favour of a polypill go something like this:

1. Cardiovascular disease is very common; indeed the commonest cause of death.
2. Many people are at risk of developing cardiovascular disease without knowing it.
3. These people can be prevented from developing cardiovascular disease by managing risk factors (blood pressure, blood clotting and dyslipidæmia).
4. As well as life style change, this involves taking many different medications daily.
5. The more tablets people are prescribed, the less likely they are to take them.
6. If the drugs are combined into one tablet, adherence would be much improved.
7. Therefore the risk of cardiovascular disease would be reduced.

The arguments against the polypill go something like this:

1. To help a few, you have to treat many.
2. Drugs such as aspirin have common side-effects.
3. Drugs are expensive.
4. Therefore it is better to target those at risk and treat them.

The latest thrust in the evidential battle came from an American, Prof Allen Taylor who said at a recent conference that it would better to check for atheroma using CT scanning or ultrasound before starting any medication.

This was counterbalanced by a recent research project which found a large reduction in cardiovascular disease in those taking a polypill compared with those taking a placebo.  Among those involved in this research was Prof Simon Thom, one of the most eminent men in this field and a first-class speaker to boot.

Incidentally, the argument against about the cost of drugs is not valid; a polypill would cost less than 30p a day !  If it halved the risk of cardiovascular disease this would rank it pretty high on a cost versus benefit basis.

So what should we be doing ?

Nothing except wait for the “bottom line”.

Why ?

1. We cannot check for atheroma using CT scanning or ultrasound because it is not available under the NHS.
2. We cannot prescribe the polypill as it is not yet available on prescription.

At the moment, we continue to assess risk in a way advocated in our course Cardiovascular  Disease Prevention in Primary Care.  When anything changes, so will our course.