Your Health Checkup: The Promise of Polypills

“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine.  Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

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I have written in the past about polypharmacy, i.e., taking multiple pills at the same time, with the potential for harmful drug-drug interactions, missed doses, or taking wrong medications. Yet, almost half of all adults take five or more medicines. Dietary supplements can add to that problem.

The reality is that the complexity of diseases such as heart failure often require multiple drugs for adequate treatment. A recent study of 558 adults 65 years or older hospitalized for worsening heart failure found that 95 percent of patients were prescribed five or more medications at discharge and 55 percent were prescribed ten or more medicines. Since heart failure predominantly affects older folks who often suffer from disorders in addition to heart failure, such as high blood pressure and elevated cholesterol, most of the medications for the patients in this study were to treat these other conditions.

A recent approach to simplify treatment has been to combine several drugs into one pill that can treat multiple problems such as elevated cholesterol and high blood pressure. The investigators of Polypill with or without Aspirin in Persons without Cardiovascular Disease (TIPS-3) noted that cardiovascular disease accounts for approximately 18 million deaths each year worldwide, with more than 80 percent of the deaths occurring in low- and middle-income countries. Since elevated blood pressure and an increase in the “bad” cholesterol (LDL) are among the most important risk factors for cardiovascular disease that can be modified, reducing them should lower mortality.

In TIPS-3, the investigators randomized 5,713 older participants (half were women) who were at risk for cardiovascular disease but had none at the start of the study, to receive a single daily polypill containing a statin to reduce LDL cholesterol, and three blood pressure lowering drugs (a beta blocker, a diuretic, and an ACE inhibitor). They then compared that polypill versus a placebo. Another group received the polypill plus aspirin, compared against a placebo.

At 4.6 years’ follow up they found that the polypill reduced major adverse cardiovascular outcomes such as heart attacks, strokes, and death from heart disease by 21 percent compared with the placebo. When combined with aspirin, the polypill reduced adverse cardiovascular outcomes by 31 percent compared to a placebo. Serious adverse effects were less common with the polypill than with a placebo.

The investigators proposed that if only half of the participants worldwide who were at increased cardiovascular risk took the polypill with aspirin, 3.5 million deaths could be avoided, which would create a significant public health benefit.

In addition to the beneficial global health impact, I think the investigators have created a concept that could be broadened. For example, there could be multiple combinations of polypills that could include a variety of commonly used drugs in one pill, such as a heart failure polypill made up of multiple heart failure medications; a heart failure-diabetic pill that included diabetic drugs; a polypill that included a pain medication; and so on.

The physician could prescribe a particular polypill tailored for a specific patient that combined three or four different drugs into one pill. This would reduce both the hassle and risk of taking five or ten different medicines into maybe two or three. Naturally there couldn’t be a polypill for every patient and every condition, but there could be enough combinations that many patients would benefit.

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