Are There Benefits of a Polypill Strategy in Treating CVD?

Since its early conception over a decade ago, the use of a polypill – medication that combines multiple active pharmaceutical ingredients – has gained significant momentum in potentially treating cardiovascular disease. In an editorial published Aug. 4 in the Journal of the American College of Cardiology (JACC), José M. Castellano, MD, PhD, of the Cardiovascular Institute, Mount Sinai Medical Center in New York, and his co-authors including Valentin Fuster, MD, PhD, MACC, editor-in-chief of JACC, provide a litany of arguments for the unique advantages of a polypill strategy and its preventative efficacy, safety, tolerability and affordability.

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According to the authors, several pilot studies have already demonstrated the feasibility of the polypill’s primary and secondary prevention of cardiovascular disease, including the large, randomized Indian Polycap Study (TIPS-1 and TIPS-2), the PILL study, and the UMPIRE study, as well as several independent investigations, all of which showed positive treatment in reducing blood pressure and low-density lipoprotein cholesterol. The authors cite a number of ongoing studies that are currently testing the ability of different polypills to reduce the presentation of new cardiovascular events in real-world practice, testing a combination pill against placebo.

Citing the benefits of an increased medication adherence and a simplified delivery system in addition to these successful treatment results, the authors address the significant economic burden of cardiovascular disease and the cost-effectiveness of a polypill regimen. They note that based on projected data, the cost associated with treating cardiovascular disease will triple between 2010 and 2030 in the U.S., from $273 billion to $818 billion. Much of this increase can be traced to the important but expensive new technologies and treatments of modern medicine, as well as the fact that people are surviving longer, and therefore requiring more health care over their lifetime. Administered as a simple, one-pill-per-day regimen, with no substantial tolerability issues or monitoring requirements, the authors argue that a polypill can be distributed as a cost-effective alternative to its multi-pill counterparts in both developed and underdeveloped countries, the latter of which already face a shortage of physicians, clinics and affordable income for treatment.

While there is growing concern that patients will regard the polypill as an excuse to potentially replace their own healthy lifestyle efforts, and that it will protect them from all cardiovascular risk, the authors note that no such evidence thus far has indicated that individuals knowingly taking the medication have endured such adverse change. Acknowledging that the use of a polypill for cardiovascular prevention is still relatively novel, and that data from clinical trials are accumulating, Castellano and his colleagues ultimately feel that the polypill has the potential power to change the face of health care across the world, and could be a viable solution against the burden of cardiovascular disease.

Clinical Topics: Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins

Keywords: Medication Adherence, Cost-Benefit Analysis, Life Style, Secondary Prevention, Cholesterol, LDL, Risk Factors, Blood Pressure, Cost of Illness

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