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A 'polypill' to fight heart disease?

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VIENNA, Sep 04, 2003 (United Press International via COMTEX) -- One pill to lower cholesterol, another to reduce high blood pressure, still another to combat diabetes and one more to prevent blood clots -- for millions of people with heart disease or a risk of suffering a heart attack or stroke, it takes a handful of pills every day to make sure the old ticker keeps lub-dubbing along.

Why can't all those pills be combined into just one tablet -- a polypill?

Such a pill, if it could be created, might encourage people to stay on their medication and, in turn, reduce the number of heart disease related deaths dramatically.

"It looks good on paper," said Dr. Mark Alberts, professor of neurology and director of the stroke program at Northwestern Memorial Hospital in Chicago.

"The proponents of polypills or superpills predict that if people at risk could take just one pill regularly they could cut incidence of heart disease by 80 percent," he said at a symposium during the European Society of Cardiology Congress 2003.

"The question is," Alberts continued, "Who will step up to the plate to do it?"

Writing recently in the British Medical Journal, Dr. Nicholas Wald, professor of environmental and preventive medicine at the University of London's Wolfson Institute of Preventive Medicine in Britain, suggested the creation of a polypill. The pill would be a combination of a statin drug to lower cholesterol, three blood-pressure-lowering drugs, and folic acid to lower levels of homocysteine -- a marker of heart disease.

"The polypill strategy could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing cardiovascular disease," Waldhe wrote. "It would be acceptably safe and with widespread use would have a greater impact on the prevention of disease in the Western world than any other single intervention."

That assumes, of course, that everyone who is prescribed a polypill takes it. "The problem with pills is we are asking people to take something -- eat something -- that they don't get any enjoyment from." said Dr. Sidney Smith, Jr., professor of medicine at the University of North Carolina at Chapel Hill.

That is exactly the point, doctors say. Staying on a prescription is one of the main reasons doctors would welcome the polypill. Many patients, even those who have suffered heart attacks, tend to stop taking their medication.

"Compliance with drug regimens is very difficult for patients," said Dr. Sarah Jarvis, a general practice physician in London. "Compliance with a healthy lifestyle that might eliminate the need for a polypill is even more difficult."

Dr. Keith Fox, professor of cardiology at Scotland's University of Edinburgh, agreed. Eating a better diet, exercising more and stopping smoking, he said, could make the polypill unnecessary.

Despite massive evidence that living healthy reduces the risk of heart disease significantly, doctors often fail to encourage their patients to adopt such lifestyles. Nor have they had much success in persuading patients to take all their pills when they are supposed to take them. Which is why an all-in-one superpill might be more effective in the fight against heart disease -- the world's deadliest and most common killer.

One major problem with a polypill, however, Smith explained, is it would require cooperation among the pharmaceutical manufacturers -- not an easily imagined situation, given their normally aggressive competitive tendencies.

Yet the prospect might not be out of the question.

"The concept of a polypill is fascinating, but there are a lot of things to work out," Brian Henry, senior manager for corporate affairs at Bristol-Myers Squibb Company in Princeton, N.J., told United Press International. "What is the best statin to use? What is the best high blood pressure drug to use? What are the best doses?"

Henry said all those questions would have to be examined, along with whether the drugs, if packaged in one tablet, would produce unwanted interactions. He said a polypill also would have to be tested to determine if it performed as effectively as its constituent drugs did individually.

Bristol-Myers Squibb, and its marketing partner, Sanofi-Synthelabo in Paris, manufacture several drugs that, conceivably, could be packaged into a polypill, he said.

Copyright 2003 by United Press International.

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