A new proposal from University College London (UCL) suggests that providing a single “polypill” to everyone in the UK aged 50 and over could dramatically reduce the number of heart attacks and strokes each year. The polypill would combine a statin and three blood pressure-lowering medications, offering a simple, cost-effective alternative to the current NHS Health Check.
In an opinion piece published in The BMJ, UCL researchers argued that the polypill could be a game-changer for disease prevention, shifting the focus from treating illness to preventing it altogether. The researchers believe this strategy would be far more effective than the current system, which targets individuals aged 40 to 74 for regular health checks and prescriptions based on risk assessment.
According to the researchers, only 8% of people aged 50 and above would need to participate in the polypill program for it to have a greater health benefit than the NHS Health Check. This initiative, they claim, could prevent thousands of heart attacks and strokes annually.
Polypill Program: A Cost-Effective Solution
The proposal advocates for a national rollout of the polypill, accessible to all individuals aged 50 and over. The researchers point to a 2003 paper that suggested a similar approach could prevent up to 80% of heart attacks and strokes in people aged 55 and above. The findings of this study have been supported by numerous clinical trials conducted in various countries over the years.
Professor Aroon Hingorani, co-author of the paper and Director at the UCL Institute of Health Informatics, emphasized that the current NHS Health Check program is not performing well, with low participation rates and insufficient prescription of preventative medication. He explained that traditional risk prediction tools often fail to accurately identify those at risk, as most heart attacks and strokes occur in individuals with average risk levels.
A polypill program, Hingorani argues, would provide a simple, low-cost approach to prevention. The medications involved are off-patent and inexpensive, and statins have long been shown to have minimal side effects. Combining three blood pressure-lowering drugs at low doses further reduces side effects while enhancing their overall benefits.
Evidence from Clinical Trials
The proposal is supported by evidence from clinical trials, including a 2019 randomized trial conducted in rural Iran. The study showed that participants who took a polypill for five years experienced a 33% reduction in heart attacks and strokes.
In addition, an analysis published last year found that the polypill program would provide more than twice the benefit of the current NHS Health Check in terms of years of life free from heart attacks and strokes.
Professor Sir Nicholas Wald, co-author of the study, compared the polypill strategy to other successful public health initiatives, such as vaccination programs and efforts to reduce salt in food. He argued that the polypill is not a “medicalization” of the population but rather a preventative measure to keep people healthy and avoid the need for treatment.
Next Steps: Pilot Program and Policy Changes
The UCL researchers suggest that the next step should be a pilot project to assess how best to implement a national polypill program. The pilot would evaluate factors such as uptake, adherence, and cost-effectiveness.
As local authorities are legally required to provide NHS Health Checks, the researchers acknowledge that a directive would be necessary to authorize the replacement of the current system with the polypill program.
“The status quo is not a justifiable option,” the researchers concluded. “We have the means to prevent most heart attacks and strokes; we must now translate that knowledge into action.”
A Growing Public Health Concern
In the UK, over seven million people are living with cardiovascular disease, and each year, around 100,000 people suffer heart attacks and another 100,000 experience strokes. The proposed polypill program could represent a significant step forward in addressing this pressing public health challenge.
The proposal is the result of discussions at a seminar organized by UCL, bringing together leading experts in cardiology, neurology, epidemiology, pharmacology, and public health policy to explore innovative strategies for preventing heart disease and stroke.
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