Single pill combining five heart drugs appears safe
Published Tuesday, March 31, 2009 8:51AM EDT
Imagine if people at risk of heart disease could take a single pill that would contain all the medications they need to reduce their heart risk. Such a pill is already a reality and now new research suggests it's safe and effective.
It's called a polypill and could soon become a cheap, simple way to prevent both heart disease and stroke.
The formulation studied in this latest research is called Polycap and contains five medications:
- aspirin to prevent blood clots
- simvastatin, a statin to lower cholesterol
- atenolol, a betablocker used to treat high blood pressure
- ramipril, an ACE inhibitor also used to treat high blood pressure
- hydrocholorothiazide, a diuretic also used to treat high blood pressure
Researchers led by Dr. Salim Yusuf of the Population Health Research Institute at Hamilton Health Sciences and McMaster University conducted a short-term study in India to see if combining these five medications into one pill was as effective as each medication alone.
They recruited 2,053 people across India who were between the ages of 45 and 80 who had no heart disease but had one risk factor for it, such as type 2 diabetes, smoking, or abnormal cholesterol levels.
They divided the volunteers into nine groups: one received the polypill marketed as Polycap; the rest received either the medications alone or in different combinations.
The researchers found the Polycap effectively reduced blood pressure, LDL cholesterol, and heart rate.
Compared to groups given no blood pressure medicines, those who received the polypill lowered their systolic blood pressure (the top number) by more than seven units and their diastolic (the bottom number) by about six.
The drops were modest, probably because most participants had only moderately high blood pressure to start with and doses were low, Yusuf said.
LDL, or bad cholesterol, dropped 23 per cent on the polypill versus 28 per cent in those taking the statin separately. Triglycerides dropped 10 per cent on the combo pill versus 20 per cent with individual statin use. Neither pill affected levels of HDL, or good cholesterol.
Anti-clotting effects seemed the same with the polypill as with aspirin alone.
What's more, the researchers found no additional side effects from combining all five medications into one pill compared to those who took the meds separately.
The results of the study will be published in an upcoming edition of The Lancet and are also being announced at the American College of Cardiology meeting in Florida.
The researchers believe the pill could massively reduce future incidence of heart attack and stroke in otherwise healthy people at risk of heart disease. They say the combined effects of all the medications in the Polycap could potentially reduce the rate "cardiovascular events", such as heart attacks and strokes, in these people by half.
The pill is not meant to replace the healthy eating, exercise and other lifestyle factors needed to lower the risk of heart attack. But it should help patients who have trouble taking multiple medications, says Dr. Ruth McPherson, the director of the Lipid Clinic and Lipid Research Laboratory at the University of Ottawa Heart Institute.
"Number one, it will reduce the cost of the pills. And it will improve compliance. We know that more people are apt to take one pill compared to five or six pills," McPherson told CTV News.
Research suggests that many patients on multiple medications skip doses, believing that since they feel well, they don't need so many pills. Others regularly forget one or two of the meds in their regimens, putting themselves health at risk or a heart attack of stroke.
The study authors stress that their findings are preliminary and that longer and larger studies are needed to evaluate the longer-term effects of the medications.
As well, more research is needed on combining different strengths of each of the medications.