Widespread availability of polypills could reduce the risk of cardiovascular disease, cardiologists say

Widespread availability of polypills could reduce the risk of cardiovascular disease, cardiologists say

Global health has paid a deadly price for failing to widely use simple, inexpensive blood pressure-lowering drugs, statins and aspirin, in the form of a single pill, also known as a polypill, two leading cardiologists say in a commentary published in The Lancet. Widespread availability of polypills would significantly reduce the risk of cardiovascular disease (CVD) and be affordable for most people worldwide, their call to action says.

Despite considerable scientific evidence supporting the high effectiveness, safety and affordability of the polypill, few such combination products are available and in the few countries where they are available, use is low.”

Prof. Fausto Pinto, President of the World Heart Federation

“This systemic failure is a global tragedy as many premature deaths from cardiovascular disease could be avoided,” says Prof. Salim Yusuf, executive director of the Population Health Research Institute (PHRI) and professor emeritus of medicine at McMaster University.

Approximately 54 million people suffer from cardiovascular disease each year – a third of whom die from cardiovascular disease – with 80 percent of them living in low- and middle-income countries.

Most heart attacks and strokes affect people without prior cardiovascular disease, meaning primary prevention of the first heart attack or stroke is essential. Secondary prevention for people who already have CVD is also important, but does not have the same effect.

"The current strategy for primary and secondary prevention of CVD has been only moderately successful in most countries, including high-income countries. Even in these countries, less than half of patients with prior CVD and less than 20% without prior CVD receive effective preventive treatments," says Prof. Yusuf.

The polypill, also known as fixed-dose combination therapy (FDC)—using the combination of antihypertensive agents, a statin to lower LDL cholesterol, and low-dose aspirin—was proposed in the early 2000s as a means to significantly reduce CVD and at low cost.

“The answer is now clear and resounding, with data from three independent, large, long-term studies of primary prevention and one of secondary prevention showing its life-saving importance,” says Yusuf, whose various publications have shown that heart attacks and strokes were reduced by 35 to 50 percent with the use of a polypill.

“It is time for widespread use of the polypill to save millions of lives every year,” says Prof. Pinto. He and Prof. Yusuf recommend the following new strategies:

1. Ermutigen Sie große Pharmaunternehmen, in die Entwicklung und Erprobung von Polypillen zu investieren – insbesondere in neuere Polypillen mit größeren blutdrucksenkenden Wirkungen (z. B. die Kombination niedriger Dosen von 3 oder 4 Medikamentenklassen mit Statinen und niedrigen Dosen Aspirin). Die Herstellung mit generischen Bestandteilen und die Vermarktung von Polypillen zu lokal sensiblen Preisen würde die Erschwinglichkeit sicherstellen und gleichzeitig die Rentabilität für die Unternehmen aufrechterhalten, wodurch die Verwendung durch die Mehrheit der Menschen auf der ganzen Welt verbessert würde.
2. Die Aufnahme von Polypillen in die Liste der unentbehrlichen Arzneimittel der WHO und in Leitlinien für die Primär- und Sekundärprävention von Herz-Kreislauf-Erkrankungen ist ein wichtiger nächster Schritt. „Dies würde Regierungen und Versicherungsunternehmen, insbesondere in Ländern mit niedrigem und mittlerem Einkommen, ermutigen, sie in ihre Formulare aufzunehmen, und Kliniker, ihre Verwendung zu empfehlen“, schreiben Pinto und Yusuf.
3. Kombinieren Sie die Polypille mit Lebensstilratschlägen zur CVD-Prävention, die von ausgebildeten nichtärztlichen Gesundheitshelfern (NPHWs) durchgeführt werden – nicht als Ersatz für Ärzte gedacht, die ihre fortgeschrittenen Fähigkeiten bei der Behandlung von Personen mit komplexeren Erkrankungen einsetzen können – also eine kombinierte Strategie, die vielen helfen würde mehr Leute.

Source:

McMaster University

Reference:

Yusuf, S & Pinto, FJ, (2022) The polypill: from concept and evidence to implementation. The lancet. doi.org/10.1016/S0140-6736(22)01847-5.

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