The BMJ Today: Further adventures of the polypill

TJackson_09Remember the polypill, the combination of several active ingredients in one tablet that promised to revolutionise the prevention of cardiovascular disease? It is a question we have often asked in the offices of The BMJ, the journal in which the idea of the polypill was first mooted in 2003 by Nicholas Wald and Malcolm Law. In their paper, “A strategy to reduce cardiovascular disease by more than 80%,” they envisaged a single pill comprising aspirin, a statin, folic acid, and three types of antihypertensives. This, they claimed—if taken by everyone 55 and older and everyone with existing cardiovascular disease—could largely prevent heart attacks and stroke. A linked editorial proclaimed it as,  “one of the boldest claims for a new intervention.”

There was even a polymeal, a menu that sought to recreate the benefits of the polypill, and a polymeal competition, judged by Raymond Blanc and won by a general practitioner from Falkirk, who came and cooked her menu for us at BMA House. It was delicious and felt wonderfully guilt-free.

But then we seemed to hear little more. In 2008, we published a feature asking, “Whatever happened to the polypill?” Although some work was under way exploring the possibilities of such a pill, there were no trials, and no polypill formulation had been licensed in Europe or America.

Forward six years, and the picture changes. Today on we report that there are several versions of the polypill, and that they have just been subject to a systematic review by the Cochrane Collaboration. The researchers found that, yes, polypills do have a role in “protecting large populations against cardiovascular disease,” but the different formulae in the various versions of the pills meant it was hard to say “there is a single effect size from the polypill.”

The BMJ reports that “polypills have yet to be shown to reduce mortality or events such as heart attacks and stroke, but that they do reduce risk markers for these events such as blood pressure and cholesterol.” One benefit of a polypill, suggested by the one of the trials under scrutiny, was that a single tablet increased adherence to treatment by up to 33%.

One of the Cochrane researchers, Mark Huffman, told The BMJ’s reporter, “Within the cardiovascular community there is a debate.” Some argued that the bar needed to be raised, he said. “We need to demonstrate that it [the pill] prevents heart attacks and strokes. Some say these are proven drugs in the secondary prevention setting and we are trying to evaluate the effect of a different delivery system.”

Trevor Jackson, deputy editor, The BMJ.