Polypill - Mirage or Miracle

BMJ 2007;334:172 (27 January), doi:10.1136/bmj.39101.539352.DB

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NEJM sees promise in polypill for low and middle income countries

Janice Hopkins Tanne

¹ New York

A "perspectives" commentary in the New England Journal of Medicine by a leading Indian cardiologist says that a "polypill" to combat heart disease "would be quite cost-effective in reducing the burden of cardiovascular disease even in low-income and middle-income countries" (New England Journal of Medicine 2007;356:3).

The polypill, a combination of a statin, aspirin, drugs to lower blood pressure, and folic acid, was first proposed by Nicholas Wald and M R Law of the Wolfson Institute of Preventive Medicine, Barts, and Queen Mary's School of Medicine and Dentistry at the University of London in the BMJ (2003;326:1419).

In the commentary, Srinath Reddy, president of the Public Health Foundation of India and professor of cardiology at the All India Institute of Medical Sciences in New Delhi, says that drugs for primary or secondary prevention of cardiovascular disease have not been widely used even in developed countries.

"Poor adherence to multidrug regimens is a common barrier to effective therapy. In low and middle-income countries, the unaffordable cost of such regimens represents another obstacle," he writes.

The polypill might prove useful, but Dr Reddy noted that other experts have proposed different combinations of four or five drugs.

"The availability of most of these drugs in a generic form may help to reduce the cost of a polypill, especially in countries such as India, with its active generic drug industry," Dr Reddy writes.

The World Heart Federation recently announced that it would support the development of a polypill containing aspirin, an angiotensin converting enzyme inhibitor, and a statin. Two Indian drug manufacturers have developed a combination pill that also includes a blocker and will soon begin clinical trials, he writes. However, trials are needed to show "whether the polypill is a miracle or a mirage."