Background:
Every so often, people ask me if heart attacks, strokes, and other types of cardiovascular disease can really be prevented. After all, everyone has heard of people who were supposedly in great shape, like the famous runner, Jim Fixx, who dropped dead of a massive coronary. And since he ate right and exercised diligently, why did this happen? In short, he had a lot of risk factors for heart disease: he had a family history of heart trouble (his father died of a heart attack at age 43), he was born with an enlarged heart, and before he took up running, he smoked two packs of cigarettes a day. In my practice, we aim to make people aware of their personal risk factors, then give them every tool we have in our modern medical arsenal to reduce those risks. One of these tools may be a preventive “polypill.”
Rationale for the Polypill:
Based on the established knowledge that aspirin taken daily can significantly reduce the chances of having a heart attack through its anticoagulant (blood-thinning) properties, Australian researchers set out to formulate a combination preventive “polypill” that included aspirin, hydrochlorothiazide (to reduce blood pressure), lisinopril (Zestril) – to both reduce blood pressure and decrease the amount of work the heart has to do – and simvastatin (Zocor), one of the well-known cholesterol-lowering “statin” class of drugs.
Study design and results:
In the Australian study, 378 patients participated; none of them had any obvious need for any component of the polypill. However, all of them had a greater-than-average predicted risk of cardiovascular disease on a five-year basis. The results indicated that over just 12 weeks of treatment, the subjects’ systolic blood pressure dropped an average of 9.9 mm-Hg while their LDL (bad) cholesterol levels decreased by an average 0.8 mmol/L. The authors of the study suggest that over five years, this simple pill could reduce the incidence of cardiovascular events like heart attack and stroke by as much as 50-60%!
What it all means:
To me, this is huge! It is evidence that reinforces the viability and effectiveness of preventive strategies in cardiology. Someday, this kind of polypill approach may become standard therapy for people with increased cardiac risk. But while researchers continue to do more studies, I believe that we can take a lesson from this data now. In my practice, I am committed to using the latest techniques for early diagnosis of cardiovascular risk and the most innovative therapies available to lower that risk. While I do not offer the “polypill” in my office, many patients could be candidates to receive some or all of its components, as well as customized variations. To this, we can add other natural products, such as vitamins and other nutritional supplements that are known to reduce inflammation – a major factor in the development of cardiovascular disease. By integrating these treatment methods, we give patients the best possible chance of preventing dangerous cardiovascular events.