London School of Hygiene & Tropical Medicine

Taking one pill instead of three could be a powerful ally to prevent cardiovascular disease, according to a new Cochrane systematic review of the latest research on polypills from a team of scientists at the London School of Hygiene & Tropical Medicine, Warwick Medical School and Northwestern Medicine®.

Researchers found that the combination therapy - taking one pill instead of three separate pills - made it easier for people to adhere to a treatment plan. Polypills were shown to improve adherence by up to 33% compared with those who underwent usual care for cardiovascular disease prevention.

The review showed that a polypill lowered systolic blood pressure and total cholesterol but the overall effects of a polypill may be similar to usual care. Adverse events were more common in people treated with a polypill but there was no strong evidence of a difference in serious adverse events between those taking a polypill and those on placebo or control.

A polypill typically combines an aspirin, statin and at least one blood pressure medication into a single pill. The idea of putting multiple drugs into a single pill is not new; it is done in HIV combination therapy, for example. However, polypills have the potential for widespread use and could potentially help prevent heart attacks and stroke while helping people live longer. Such drug combinations are not yet on the market in the US or the UK but can be bought online.

The review included analysis of 7,047 patients in nine randomised controlled trials from around the world from 2009 to 2013 and is the largest and most comprehensive review of polypill literature to date.

Study co-author Professor Shah Ebrahim, from the London School of Hygiene & Tropical Medicine, said: "Cardiovascular diseases, including heart attacks and strokes, are the leading cause of death and disability worldwide. In the Britain, they cause about a third of all deaths - more than 180,000 each year. Lowering blood pressure and cholesterol levels by introduction of a polypill could simplify treatment, improve adherence and thereby save lives and reduce health care costs."

Study co-author Dr Mark Huffman, assistant professor in preventive medicine and medicine-cardiology at Northwestern University Feinberg School of Medicine and a cardiologist at Northwestern Memorial Hospital, said: "We know that half of the people around the world who have had a heart attack or stroke take zero medicines after the incident. A single polypill could not only make it easier for patients to take their medications, but could also provide the maximal benefit from a single pill. However, there is not going to be one magical pill for everybody. I think we can expect different polypills with different doses of medication."

Huffman added that the polypill has the potential to be added to the World Health Organization's Model List of Essential Medicines in the future, maybe as soon as next year: "The WHO has already named the polypill one of the 'top five best buys' for preventing chronic diseases globally, and while more research is needed, the polypill has the potential to avoid millions of premature deaths and related morbidity from cardiovascular disease at low cost."

The study was funded by the Feinberg School of Medicine, Warwick Medical School, University of Warwick, UK, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, UK, NIHR Cochrane Programme Grant, UK, the National Institute for Health Research Collaboration for Leadership in Applied, Health Research, Care West Midlands at University Hospitals Birmingham and NHS Foundation Trust, UK.

Publication

• de Cates AN, Farr MRB, Wright N, Jarvis MC, Rees K, Ebrahim S, Huffman MD. Fixed-dose combination therapy for the prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD009868. DOI: 10.1002/14651858.CD009868.pub2.