You may have seen in the news this week an article about the polypill. This caught my eye for a few reasons. Back in 2005 I was a cardiology registrar in London, and one of my bosses was heavily involved in research into the polypill. Interestingly, his father, Professor SIr Nicholas Wald, was one of the early researchers himself into the concept at University College London, and co-wrote the op ed in this week’s British Medical Journal which made the national news.
The polypill, then, has been around as a concept for many years. But what actually is it? The idea is that a number of medications can be combined in a single pill, and dished out routinely to all the population above a certain age. There have been a few iterations, but typically includes a statin, up to 3 blood pressure lowering medications at low doses, and possibly low dose aspirin.
At a population level, the thinking is that this could replace the NHS health checks. These are meant to be carried out every 5 years from the age of 40, but take-up is poor. I expect this may in part be due to a lack of awareness of the checks. I wasn’t offered one at 40 or 45, and a straw pole of some friends tells me they weren’t either. GPs are so busy with all their other pressures I can easily understand why they often don’t have the bandwidth to perform heart screening.
This is important, as over 100,000 people each year have a stroke, and around that number have a heart attack. This costs the UK £10 billion per year in direct healthcare costs, and £25 billion in lost productivity.
The polypill itself seems to be well tolerated in studies, which I have to say in itself surprises me a bit. Maybe keeping the doses of the constituent medications low helps.
How about its effectiveness? A randomised cross-over study in 2012 showed a reduction in blood pressure of 20mmHg, and a 40% reduction in LDL cholesterol. At 5 years, a reduction in major cardiovascular events like heart attacks and strokes of around one-third has been reported, rising to 50% with really good adherence to the pill, The modelling suggests that if 8% of the population over 50 years old took a polypill, then that would outperform the current NHS screening strategy.
I turn 50 in the not-too-distant future, so I have to ask myself, would I want a polypill without any other medical assessment? For me, the answer is a no. If I had high blood pressure that could not be managed through lifestyle measures, I would have no problem taking blood pressure medication. If I knew on a scan of my arteries that they had some furring up, I would have no problem taking a statin. I just don’t think I would take one without even meeting a doctor to be assessed.
However, just because I wouldn’t take it myself without good reason, that doesn’t mean it isn’t a valuable strategy at a population level. Many people would probably be fine just to take something they knew was probably doing some good, and not bother about seeing a doctor at all. We certainly need to do something, as the status quo, particularly with the current obesity and diabetes epidemic, is costing our population health and our economy dear.
What would you do? Would you take it if offered? As it’s not currently available, just make sure as far as possible you have all your own risk factors managed. I may sound like a stuck record, but blood pressure, body weight, diabetes, and cholesterol are all highly modifiable these days. I hope you found this interesting, and certainly food for thought.