A new study in The Lancet, reported in the New York Times, revealed that the multivitamin equivalent of heart medication does a remarkable job in preventing heart attacks. The research found that this medication, known as the polypill, reduced the rate of heart attacks by more than half among those who regularly took it.
The study looked at polypills containing multiple medications for preventing cardiovascular disease (CVD).
It’s easier to take one pill
Dr. Krishnan Ramanathan, a cardiologist at St. Paul’s Hospital, is not surprised by the results of the study as he’s been prescribing with great success the polypill predecessor: the single combination pill. Containing two medications, these pills are commonly used in the treatment of diabetes, heart failure, hypertension, and high cholesterol.
Cardiologists frequently prescribe single combination pills, such as for high blood pressure, because two meds administered at once have a proven efficacy.
And Ramanathan says that bundling meds is also easier on patients.
“People find it much easier to remember taking one, including at one time,” says Ramanathan. “It decreases pill burden. We’re always concerned about patients taking five meds. This helps patients, makes taking several medications more palatable for them.”
Challenges around changing doses
Dr. Krishnan Ramanathan, St. Paul’s cardiologist
However, one major drawback of single combination pills and polypills is that, if there are medicines that involve multiple doses, then changing those doses may be more challenging. Once treatment is started, patients may have adverse effects or side effects. Ramanathan says that sometimes if you start someone on a medication and it’s not tolerated, you won’t know if the problem is with drug A or B.
“For example, if you combine a water tablet with an ACE inhibitor (medication that widens or dilates blood vessels) and the patient experiences a cough, it is most often associated with the ACE inhibitor,” says Ramanathan. “However, if the patient is nauseous or has a rash, that’s a common side effect with any medication. So was the nausea or rash due to drug A or B? Both can cause these side effects.”
St. Paul’s the official Vancouver site for TIPS-3 study
Dr. Carolyn Taylor, a cardiologist at St. Paul’s healthy heart program, says that taking The Lancet findings a step further and studying the role of a polypill in primary prevention in a multinational context will help provide valuable information on the use of this strategy in other health care systems and countries.
And she is poised to do just that, leading with Dr. Scott Lear the Vancouver site for the International Polycap Study 3 (TIPS-3) for the evaluation of polycap (a single pill containing multiple medications), low dose aspirin and vitamin D supplementation in primary prevention of CVD, cancer and fractures.
Dr. Carolyn Taylor, cardiologist, St. Paul’s healthy heart program
Vancouver trial to end next March
The goal is to recruit 150 to 200 participants from the Vancouver site who will be followed for five years. The trial is anticipated to end in March 2020. The study will be conducted in 11 countries with more than 5,000 participants. It is coordinated and sponsored by the Population Health Research Institute, McMaster University and Hamilton Health Sciences, in collaboration with research teams at each of the study sites.
“We urgently need to develop effective preventive strategies. The preferred population-based strategy is to implement policy level changes that can reduce tobacco use and improve nutrition and physical activity levels,” says Taylor. “Given these strategies will take time to nurture over the coming decades, a more immediate approach is to modify and treat the major risk factors for CVD with combinations of simple, proven, safe, widely available and inexpensive drugs.”
