2 September 2011
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:
- Cardiovascular disease is very common; indeed the commonest cause of death.
- Many people are at risk of developing cardiovascular disease without knowing it.
- These people can be prevented from developing cardiovascular disease by managing risk factors (blood pressure, blood clotting and dyslipidæmia).
- As well as life style change, this involves taking many different medications daily.
- The more tablets people are prescribed, the less likely they are to take them.
- If the drugs are combined into one tablet, adherence would be much improved.
- Therefore the risk of cardiovascular disease would be reduced.
The arguments against the polypill go something like this:
- To help a few, you have to treat many.
- Drugs such as aspirin have common side-effects.
- Drugs are expensive.
- 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”.
- We cannot check for atheroma using CT scanning or ultrasound because it is not available under the NHS.
- 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.