Robert O. Bonow, MD
Robert O. Bonow, MD, Goldberg Distinguished Professor, Northwestern University Feinberg School of Medicine, Chief, Division of Cardiology, co-director, Bluhm Cardiovascular Institute Northwestern Memorial Hospital.
One pill prevents it all. At first pass, some might think the proposal to prescribe a preventive polypill to people at risk for heart disease sounds like a great idea — the combo capsule would blend several preventive medications into one, making it easy and efficient for everyone, including doctors, patients and pharmacies. In reality, however, there are problems with this proposal. In fact, the pros and cons of this new cardiovascular polypill product was a top topic at this year’s annual meeting of the American College of Cardiology, with plenty of arguing on both sides of the issue.
I’ve seen numerous TV ads for products that combine different drugs into one dose, including blood pressure medications and over-the-counter cold remedies. The cardiac polypill proposal presented at the ACC Conference takes this in a new direction as a preventive medicine, intended to keep heart disease away from people who aren’t yet sick. Called the “Polycap,” it contains three blood pressure-lowering medications at low doses, plus a statin and aspirin. A three-month study of 2,053 participants found this product brought about slight reductions in both blood pressure (systolic BP was reduced by 7.4 mmHg compared with those not receiving blood pressure drugs)… and LDL cholesterol by 0.70 mmol/L… and was well tolerated.
Some believe wide use of such drugs is worth considering. A study published in the British Medical Journal in 2003 claimed that this polypill cocktail could reduce ischemic heart disease events by 88% and stroke risk by 80%. The study’s authors claimed that such a strategy “would be acceptably safe and with widespread use would have a greater impact on the prevention of disease in the Western world than any other single intervention.”
My own list of concerns about this strategy is a long one, but I called Robert O. Bonow, MD, Goldberg Distinguished Professor at the Northwestern University Feinberg School of Medicine, to see what an expert cardiologist might say. He said he believes Americans would love a pill “you take every day that allows you to continue to eat what you like and to smoke and not exercise,” but he doesn’t believe it’s a good health strategy because it sends the wrong message and elicits the wrong behavior. Dr. Bonow said that a better solution would be funding of better strategies for lifestyle, better exercise facilities, more health messages, better advertising on television for kids so they aren’t seeing all the soft drink and chip ads, etc.
Dr. Bonow pointed out there are serious potential medical problems associated with widespread use of this polypill plan, too. Each of the drugs in the pill has its own associated risks, he pointed out — for instance, aspirin can increase the risk of bleeding, while statins can cause liver damage, memory loss and other serious health problems for some people. Mixing a variety of drugs into a single pill may increase the risk of side effects and interactions, perhaps exponentially. If side effects arise, how do you ascertain which of the drug components is causing the problem — is it the combination of drugs, a particular one or does the dosing of one or several of the ingredients need to be tweaked to get the “just right” level? Also, dosing should be adjusted so that each patient receives the right amount of each drug to reach his/her goals, and the fixed doses contained in a polypill mean that some patients would be under-treated, while others would be over-treated. Paradoxically, the polypill may create more problems than it solves.
People who want effective treatment and prevention would do better to discuss their lifestyle and risk factors with their doctors to figure out what changes are necessary to improve health. Keep track of your cholesterol level, with an eye toward achieving your target level. Be aware of your blood pressure. If you take one or several medications to help you reach the right levels, be sure you are taking the doses that are right for you. This pill won’t serve as a substitute for taking better care of yourself… and I don’t expect one ever will.