A single “dish”, at times, is ideal for tasting all the nutrients without necessarily having to consume three different courses. At table, it happens that you do not want to taste everything at the right doses or do not have time. Something similar could also happen when truly life-saving treatments need to be carefully followed. Similarly, in fact, the possibility of having three active ingredients aimed at controlling important risk factors for the heart and arteries in a single administration could help us to better protect people who have had a heart attack from new serious episodes and from death, compared to medications taken one by one.
To say it are the results of the study SECUREpresented at the European Congress of Cardiology (ESC) in Barcelona and published in the New England Journal of Medicine. In general terms, the advantages of this “simplified” approach appear clearly: the polypill consisting of three drugs, an antihypertensive, a statin to lower cholesterol and aspirin, reduces the risk of stroke and heart attack by 30% in those who have already had a heart attack.
The polypill as an aid to therapeutic adherence
As he told Valentine Carpenter of the Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, and the Mount Sinai Health System of New York, “SECURE results show, for the first time, that a polypill containing aspirin, atorvastatin and ramipril leads to clinically relevant reductions in recurrent cardiovascular events in patients with post-heart attack myocardial infarction “.
The doctor prescribes but the patients (almost a third) do not follow the therapy
According to the expert, the main researcher of the study, only less than 50% of patients, even after a heart attack, get to correctly take the classic medicines indicated for prevention, namely an antiplatelet drug, one to reduce LDL cholesterol and one to control the pressure. For this reason the hypothesis is that the polypill can help the sick to treat themselves consistently over time with consequent protective effects.
How much the risks are reduced
Precisely to influence the decline in adherence to treatment, which can occur already a few weeks after the heart attack, patients were involved in the study within six months of the acute event. The average age of the participants (over 2,500 collected in seven countries, including Italy) was 76, 31% were women, 77.9% suffered from hypertension, 57.4% had diabetes and 51.3 % had a history of smoking.
On average, the subjects included in the study were followed for three years: new heart attacks, strokes or death from cardiovascular causes were observed in 9.5% of patients treated with polypill and in 12.7% of subjects treated with standard therapy. In particular, death from cardiovascular problems was detected in 3.9% of patients in the polypill group and 5.8% in the group that took the classic drugs separately. Fuster says: “The results suggest that a polypill could become an integral part of strategies to prevent cardiovascular events in post-heart attack patients.”
Heart door
Cardiovascular diseases, how to promote therapeutic adherence
by Federico Mereta
Advantages and disadvantages of the polypill
“The polypill, containing aspirin, an Ace inhibitor (to control blood pressure) and a statin was found to be more effective than standard treatments in reducing cardiovascular risk in patients with a previous myocardial infarction, but without affecting all-cause mortality – comments Ciro Indolfi, president of the Italian Society of Cardiology (SIC). The polypill is convenient to use for patients as it combines different drugs in a single tablet that is taken only once a day, thus simplifying the therapy and improving adherence, a mechanism responsible for the benefits of this therapeutic strategy “. always evaluate case by case, because each patient has his own history and needs.
“The polypill containing three drugs in fixed doses does not allow to optimize the therapy and there could be the risk of under-dosage, due to the impossibility of adjusting the individual components of the polypill based on the needs of each patient – continues Indolfi. a practical obstacle also remains, such as the lack of commercial interest “.
Hypertension, taking pills in the morning or evening doesn’t matter. But don’t forget them
by Federico Mereta
