In 2003 in the BMJ, Wald and Law and a supporting editorial by then editor Richard Smith, proposed that 80% of heart attacks and strokes could be prevented by widespread use of a six drug polypill. The six ingredients were a statin, three low-dose antihypertensives (a thiazide, an ACE inhibitor and a beta blocker), folic acid, and aspirin.
Although there was a lot of derision at that time and there has hardly been indiscriminant obedience to this proposal, I have always thought it made a lot of sense.
There are costs, but the agents as generic are not very expensive.
There are adverse effects to consider for all six drugs, but most of them have been overblown, especially re: statins, to my point of view.
We could probably drop the folic acid to make it a group of five, since homocysteine as a villain did not play out that well.
Now, new evidence about yet another benefit from statins.
In 2010, Agarwal and 4 colleagues at the University of Connecticut have published a meta-analysis about statin use and the prevention of venous thromboembolism in the International Journal of Clinical Practice.
Randomized controlled trials and observational studies evaluating the effects of statins on the incidence of venous thromboembolism were selected from MEDLINE (1996 to 2009), Cochrane CENTRAL (second quarter, 2009), Cochrane Database of Systematic Reviews (second quarter, 2009) and a manual review of references.
Ten studies were identified as eligible for meta-analysis. From these studies, statin use is associated with statistically significantly reduced odds of developing venous thromboembolism by 32%, deep vein thrombosis by 41%, and pulmonary embolism by 30%.
Despite major advances, cardiovascular diseases still kill more people in developed countries than any other diseases. So, let’s take another look at the five-drug polypill.
George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.
Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.
