Do the Current Medical and Economic Times Dictate the Need for the “Polypill”?

The polypill concept was proposed by British researchers Nicholas Wald and Malcolm Law in their controversial article published in 2003. Their aim was to prevent cardiovascular disease by simultaneously reducing 4 cardiovascular risk factors (low-density lipoprotein cholesterol, blood pressure, serum homocysteine, and platelet function) regardless of pretreatment levels. Their polypill version was a single daily pill containing low doses of 6 drugs: a statin, a thiazide, a bblocker, an angiotensin-converting enzyme (ACE) inhibitor, a folic acid, and aspirin. They proposed that their polypill could effectively and safely reduce myocardial infarction and stroke risk if taken by everyone aged 55 and older and everyone with existing cardiovascular disease. At this time, no polypill formulation has been licensed in Europe or America and sufficient trials have not been reported to test this novel concept. Several factors may delay successful approach of a polypill formula in the future. First of all, reasons could be due to technical difficulties in combining a variety of different drugs, and the size of a pill containing 6 drugs could be problematic. In addition, pharmacokinetic, pharmacodynamic, and dosing issues of any combination pill should be thoroughly investigated. Another important issue will be the financial hardship in finding sources for funding such research because there would be little enthusiasm in investing money and technical resources to develop an inexpensive polypill. However, recent studies favor some modifications to the components of the polypill, including concentration on specific indications that are common and important, such as hypertension, diabetes mellitus, post–myocardial infarction status, and heart failure. Ideally, there would be a combination of agents within a range of polypills for primary and secondary prevention, which would be expected to be available in the market during the next few years. Valentin Fuster and colleagues announced during the 2008 World Congress of Cardiology meeting in Buenos Aires, Argentina, that the clinical testing for a 3-agent polypill in secondary prevention is imminent. The polypill variant was developed in Ferrer Laboratories (Barcelona, Spain) and will contain aspirin, a statin, and an ACE inhibitor. This combination compound will possibly be prescribed for patients who have had a myocardial infarction. In an additional study, Anthony Rodgers, the principal investigator, announced another international trial using a ‘‘red heart pill,’’ a 4-drug polypill (a statin, an ACE inhibitor, a thiazide, and aspirin) manufactured by Dr Reddy’s Laboratories (this institution was founded by Kallam Anji Reddy in 1984 in Hyderabad, India) as primary prevention in highrisk individuals. Additionally, a phase 2 pilot study sponsored by the World Health Organization with a different formulation of the red heart pill is From the Grady Cardiovascular Research Center, Emory University School of Medicine, Atlanta, GA Address for correspondence: Bobby V. Khan, MD, PhD, Grady Cardiovascular Research Center, Emory University School of Medicine, 69 Jesse Hill Drive SE, #C247, Atlanta, GA 30303 E-mail: bkhan@emory.edu