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One pill with four drugs may lower heart risks in poor population

A single daily pill containing low doses of common medications might provide a simple, inexpensive way to reduce risks for heart attacks and stroke in underprivileged communities, researchers say.

A new study done at an Alabama health center that mostly serves people who are poor and black found that a year of treatment with a 4-drug “polypill” lowered blood pressure by 7 points and cholesterol by 11 points compared to regular care.

Those changes could translate to a 25% reduction in the 10-year risk for heart attack, stroke or other cardiovascular problems in a population particularly prone to heart disease, the researchers calculate.

“It may provide a running start in the prevention of cardiovascular disease,” lead author Dr. Daniel Munoz, a cardiologist and assistant professor of medicine at Vanderbilt University Medical Center in Nashville, Tennessee, told Reuters Health in a telephone interview. “Our data suggest it was safe and effective for a variety of patients independent of gender and independent of weight.”

Lack of income, underinsurance and the need for repeated office visits to adjust the dose of a drug may be a problem for poor patients, so “the simplicity and low cost of the polypill regimen make this approach attractive when such barriers are common,” the Munoz team writes in The New England Journal of Medicine.

But the impact of such a pill may extend beyond the poor. Fewer than half of U.S. adults with high blood pressure are treated, and most people with high cholesterol don’t receive therapy for that condition.

The polypill cost just under $1 per day. It contained one drug to lower cholesterol and three to bring down high blood pressure.

Why three blood pressure drugs? “The combination of multiple medications, each at low dose, may be better tolerated mainly because side effects are dose dependent,” Munoz explained. “These are generic, low-cost and well-established medications.”

The polypill was tested on 303 adults, three quarters of whom had an annual income below $15,000 and 96% of whom were black.

The pills were given in addition to whatever medicines the patients were already taking.

After 1 year of treatment, the doctors treating 44% of the patients had cut back on the medicines those patients had been prescribed previously, presumably because the polypill was adequately controlling blood pressure and cholesterol.

And while about half the people in the U.S. who should be taking heart medication stop within a year, 91% of patients in this trial were still taking their pills at the one-year mark.

“The simplicity of taking a single daily pill may be an important contributor to adherence,” the researchers said.

There were no serious side effects.

“This could be part of closing the health disparity gap, closing some of the barriers that the socioeconomically-vulnerable face in medical care,” Munoz said. “Where else to apply it and how else to apply it is an open question.”

SOURCE: The New England Journal of Medicine, online Sept. 18, 2019.

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