The Polypill

by John A. Rumberger, PhD, MD, FACC

There is no question that the introduction of statins into the drug armamentarium has produced untold benefits in lowering the LDL cholesterol values as well as lowering the ‘risk’ of developing heart disease.  I feel that the benefits of these medications is not just in the lowering of the LDL or ‘bad’ cholesterol but also in their powerful anti-inflammatory powers to reduce the inflammation that is part of the development of plaque in the heart and vascular arteries.

Additionally, medications that can lower blood pressure also reduce the potential inflammation in the arteries and the damage to the endothelium [a single cell layer separating the blood flowing in the arteries from the vessel wall].  Maintaining the integrity of the barrier is also a major benefit from reducing the potential for plaque inflammation in the arteries.

Low dose aspirin also is beneficial not as an anti-inflammatory as is known for the therapy of arthritis – but as a means to favorably lower the local platelet activity at the site of plaque ruptures in the vessels walls and reduce the incidence of complete thrombosis, the immediate cause of a heart attack or a stroke.

Years ago scientists conjectured that a Polypill, containing low dose statin, low dose antihypertensive medication, and low dose aspirin would be of benefit in lowing individual cardiovascular ‘risk’ by attenuating the above influences on the production and rupture of atherosclerotic plaque – the cause of almost all heart attacks and strokes.

Getting patients to adhere to use of statins, anti-hypertensive medications, and aspirin after a first heart attack is surprisingly low – despite the known benefits.  The Polypill [a single pill containing low doses of the above medications] has been proposed by many to help keep the recurrence of further heart/vascular complications in many patients.  It has also been proposed as an adjunct in preventing a first heart attack or stroke.

A recent analysis of such a Polypill has been reported in the Journal of the American College of Cardiology [JACC 2014:64:2071-2082] indicating this as a strategy to improve adherence after the first heart attack.  The authors concluded that the use of a single Polypill provided better adherence than taking each of these three medications as separate pills.

It is human nature to note that taking a single pill [such as a multi vitamin] once per day is more acceptable than taking three pills at various times per day.

In time the Polypill may be offered as a singular beneficial medication in heart and vascular disease.

John A. Rumberger, PhD, MD comments:

The problem here is that we have lived in an environment where the ‘low fat’ hypothesis, advocated by the American Heart Association and others for the past 30 years has resulted in more obese individuals and an increased incidence of diabetes in the populace.  The culprit has been further worsened by the introduction of high fructose corn syrup as a substitute for ‘sugar’ in many of our foods and especially in soft drinks.

We have become ‘addicted’ to sugar in the presumed benefits of lowering our ‘fat’ intake over the past many years.  The original research by Adkins and others has shown that carbohydrates are more of an issue than ‘fat’ in our diet.

The American Heart Association and others have now adopted issues of lowering ‘sugars’ in our diet – but the effect of denying this problem for so many years has resulted in many problems.

The average clinician has not been taught much about nutrition and knows little how to advise patients on exercise.  The admonition of ‘lose some weight and get more exercise’ is about as far as it goes.

We now have patients who are getting mediations for their obesity and metabolic syndromes that include use of statins and blood pressure medications.  Many of these people just need to know HOW to lose weight, what is the problem [and it is NOT fat in the diet] and how to properly exercise.

As a whole we would do better to properly counsel our patients on weight loss strategies, what is a proper diet, and how to properly exercise – that in my opinion is the proper ‘Polypill’.