Polypill prevents a third of heart attacks and strokes

5 October 2019

A new study in Iran has demonstrated that a polypill containing multiple medicines works very well in preventing major illnesses including heart attacks and strokes. The pill is inexpensive and could have a huge impact in low- and middle-income countries where medicines aren’t broadly used but heart disease is common. 

There are implications for developed countries too, for example, the importance of sticking to medicines to lower the risk of illness.  

What did the trial involve?

Researchers based in Iran and the UK wanted to find out whether a polypill was a safe and effective way to prevent diseases of the heart and blood vessels. They were especially interested in low- and middle-income countries where rates of heart disease are high but use of medicines is low. 

The study included 6,800 people aged 50-75 in over 100 villages in Iran. The villages were split into two groups at random. One group was given education about healthy living every 6 months, and the other group was given health education and the tablet containing four medicines to protect heart health. The polypill included a statin for cholesterol, an aspirin to thin the blood, and a diuretic and ACE inhibitor for blood pressure.

Five years later, the scientists recorded how many people had had a serious health event related to the heart and blood vessels, such as heart attack, stroke, or heart failure. 

What were the results? 

The results, published in the respected science journal The Lancet, showed that the pill was very safe and effective. And, importantly, people largely stuck to taking it as prescribed. 

The pill appeared to lower the risk of heart attack or stroke by a third over five years. 202 out of 3,421 people taking the pill had a major event, compared to 301 out of 3,417 people receiving health education alone. 

The scientists found no real differences in serious side effects between the two groups, so the risks of taking the pill were low.  

What can the results tell us? 

This is the largest study of its kind and the first to demonstrate that a fixed-dose polypill works well in lowering the risk of major health events. 

Doctors in these areas have fewer resources to assess people individually and don’t have a wide range of medicines to choose from, but diseases of the heart and blood vessels are common. 

Heart disease and stroke are the biggest causes of death worldwide, causing an estimated 17 million deaths per year, largely due to smoking, lack of activity and poor diet. The disabilities caused by these diseases puts a massive drain on resources as well as the personal misery they cause.  

In low- and middle-income countries, fewer than 40% of people with high blood pressure had been diagnosed, only 30% received treatment, and only about 10% achieved blood pressure control. There is a clearly a huge unmet need for high blood pressure treatment. 

The authors said that given the pill’s affordability, it could be part of an effective strategy for controlling these disease worldwide and to prevent the leading cause of death. 

Professor Tom Marshall, from the University of Birmingham, said. "We've provided evidence in a developing or middle-income country - and that's a lot of countries - that this is a strategy worth considering," 

There are interesting lessons to be learned for developed countries too, even though a polypill like this is unlikely to be adopted at scale. For example, how important it is to take medicines every day. 

Blood Pressure UK CEO, Katharine Jenner, says: 

“This is a really interesting study. It shows how a polypill containing inexpensive and commonly-used medicines could dramatically reduce the burden of disease around the world. 

“In wealthier countries where we have so much access to health care it shows how important it is for patients to take medicines as prescribed and for researchers and health care professionals to work on combinations of medicines that keep side effects to a minimum. Most importantly of all it shows how important it is to find those who would benefit from the medicines in the first place.”  

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