A four-in-one polypill that combines three blood pressure medications with a cholesterol-reducing drug would lower the risks of heart attack and stroke by 20-40%, doctors from nine countries, including from Bengaluru, reported on Saturday.
The polypill can be consumed alone or with aspirin with varying benefits. If taken alone, it can reduce the chances of heart attack, stroke or angioplasty by around 20% but with aspirin such chances are reduced by 40%.
The study was conducted on 5,714-plus patients in 89 centres from nine countries, including 39 centres in India over a period of eight years. The Indian leg of the trial was coordinated by St John’s Medical College and Research Institute, Bengaluru.
“A polypill is not only effective, it is likely to be cost-effective too since it is based on using commonly used generic drugs,” said Prem Pais, co-principal investigator of the study and professor at St. John’s Medical College and Research Institute.
Pais said the polypill would be expected to “improve adherence” as it combines “several effective drugs in a single pill and is taken once a day”.
The multi-medicine pill combines cholesterol-lowering simvastatin 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 Indian Council of Medical Research and a 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 is worth considering for widespread use. Costs can be further reduced for our people if and when it enters our national programmes.”
As the most common serious illness globally, cardiovascular diseases account for 18 million deaths each year, with more than 80% of those in low-income and middle-income countries. In India, nearly 30% of all deaths and 15% of morbidities are caused by cardiovascular diseases. The numbers have doubled since 1990.
“We could save millions of people from experiencing serious heart disease or stroke each year with effective use of the polypill and aspirin,” said Salim Yusuf, co-principal investigator 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, demonstrated that the benefits were maximum for those who took the medicine without interruption.
“Studies of this nature are very difficult to conduct as it involves many centres and participants have to be followed up at least twice a year. We in India recruited 49% of the total sample size. This was possible for us as we had built collaboration over two decades,” said Denis Xavier, professor at St. John’s and head of the division of clinical research.