Pill could banish heart attack risk

By ANGELA GREGORY

A pill that will largely prevent heart attacks and strokes is expected to be available to elderly New Zealanders in a few years.

Research published in the June British Medical Journal promotes the benefits of a "polypill" containing a combination of proven components for the effective prevention of cardiovascular disease.

It develops earlier pioneering work into heart disease risk management by New Zealand researchers.

Nicholas Wald and Malcolm Law, of the Wolfson Institute of Preventative Medicine in London, say combining a range of beneficial drugs into one pill would increase their consumption and slash rates of heart disease in Western countries by more than 80 per cent.

Their studies of data from 750 trials involving 400,000 people found that such a pill would have a greater impact on the prevention of disease in the Western world than any other single intervention.

The medical journal's editorial describes the work as the most important it has published in 50 years.

A New Zealand medical researcher, Dr Anthony Rodgers, reviewed the studies for the journal and said the polypill could have enormous potential both in Western and developing countries.

Dr Rodgers told the Herald yesterday that the clinical trials research unit at Auckland University's school of population health was part of an international team working to develop and test such a combination pill.

Earlier landmark trials by the unit of the components - aspirin, blood pressure and cholesterol-lowering drugs, and folic acid - had already shown their benefits.

But not all the people who could be helped by taking the various medications were getting them, said Dr Rodgers.

"It requires taking six to seven pills a day and some people don't want the bother. 'I'll rattle around if I take so many pills, doctor,' they say."

Dr Rodgers said that as the main author of the World Health Organisation's 2002 world health report he had found that combination treatments were one of the most cost-effective ways to prevent heart attacks and strokes.

Preventable cardiovascular diseases were a major killer in affluent Western societies that were characterised by high saturated-fat diets, sedentary lifestyles and increasing obesity.

Forty per cent of all deaths in New Zealand - 10,000 a year - arose from heart disease, and many sufferers were struck down or disabled in middle age, said Dr Rodgers.

The huge human and economic effects cost the country hundreds of millions of dollars a year.

Dr Rodgers estimated that a polypill could be made relatively cheaply and that clinical trials in New Zealand and other countries could start in the next few years.

But the British Heart Foundation's medical director, Professor Sir Charles George, warned against complacency.

"There is no doubt the idea of a 'pill for all ills' is enticing, but whether we like it or not the rising tide of obesity, inactivity, diabetes and continued smoking rates cannot be ignored," he said.

"A polypill should never be a licence for people to lead unhealthy lifestyles."

Dr Rodgers also stressed that the pill should not be an excuse for people to carry on smoking, overeating and not exercising.

Ideally, if the lifestyle of New Zealanders improved significantly, the "rescue therapy" provided by such a pill would no longer be needed, he said.

The Ministry of Health's chief clinical adviser, Dr Sandy Dawson, said it was very exciting research.

"We are giving very serious consideration to its potential in New Zealand."

While it was possible that the combination of the components into one pill might lessen their effectiveness, he did not believe that waslikely.

Professor Harvey White, the chairman of the Cardiac Society of Australia and New Zealand, said a combination pill was a "terrific" concept.

The director of coronary care at Green Lane Hospital, he said that previously too much emphasis had been attached to individual risk factors such as smoking, blood pressure, or cholesterol, when it was more appropriate to look at them and others simultaneously.

"This is a breakthrough."

Auckland University Professor Rod Jackson pioneered such a global risk approach to heart disease where the combination of all risks was considered more important than one major risk.

"More often than not small increases in multiple risks are far worse," said Professor Jackson, an epidemiologist.

He said that, traditionally, high blood pressure was viewed as the major risk indicator, but that was often proven wrong.

"The best treatment is that which works with all risk ... the polypill is the logical extension of that."

While the British researchers recommended that everyone in the Western world older than 55 should take the combination pill, Professor Jackson expected it would be most useful for men aged about 60 and women aged about 70.

He envisaged the polypill, or a tonic version, could eventually be used by about half of New Zealanders over 60.

Pharmac medical director Peter Moody said the question was whether putting all the already available drugs in one pill would increase their uptake.

He thought it more important to educate people of the importance of taking their medication.