Harvard Heart Letter

"Polypill" test raises questions

The more pills a person needs to take each day, the less likely he or she will do it day in and day out. That's one reason British researchers proposed what they called the polypill. It would combine low doses of several generic (and thus inexpensive) heart-protecting medications — aspirin, a cholesterol-lowering statin, and two or three different drugs to lower blood pressure — into a single pill.

Putting theory into action, the Program to Improve Life and Longevity (PILL) Collaborative Group set out to test the polypill concept in people without heart disease but at higher-than-average risk for developing it. In a 12-week clinical trial conducted in seven countries, use of a polypill (see figure) lowered systolic blood pressure by 10 millimeters of mercury and LDL (bad cholesterol) by 30 milligrams per deciliter of blood compared with an identical-looking placebo pill (PLoS ONE, May 2011). Although these respectable reductions should, in theory, translate into a 50% reduction in heart disease, the study was too small and too short to track the pill's effect on heart disease or survival.

illustration showing drug components of a polypill

Using a polypill to prevent heart disease in people who don't yet have it makes sense only if the pill is safe and causes few or no side effects. In the PILL trial, side effects such as upset stomach (most likely from aspirin) and dry cough (most likely from one of the blood pressure drugs) were severe enough that 23% of the volunteers stopped taking the polypill, compared with 18% of those taking the placebo.

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