The merits and drawbacks of so-called “polypills” continue to be debated. Researchers have recently assessed the effects of this approach using a multi-component strategy that included a statin, antihypertensives and aspirin to reduce the risk of cardiovascular disease. 5713 people without established cardiovascular disease but with increased risk were randomly to receive a polypill (containing 40 mg of simvastatin, 100 mg of atenolol, 25 mg of hydrochlorothiazide, and 10 mg of ramipril), or to one of several other arms of the study – placebo daily, aspirin (75 mg) or placebo daily, and vitamin D or placebo monthly. In the polypill-alone and polypill-plus-aspirin comparisons, the primary outcome was death from cardiovascular causes, myocardial infarction, stroke, resuscitated cardiac arrest, heart failure, or revascularization. For the aspirin comparison, the primary outcome was death from cardiovascular causes, myocardial infarction, or stroke. Safety measures were also assessed. Mean follow-up was 4.6 years.
As would be expected, the polypill was able to reduce the low-density lipoprotein cholesterol concentration and systolic blood pressure, when compared to placebo. The primary outcome was observed in 4.4% of participants in the polypill group and 5.5% in the placebo group (hazard ratio, 0.79; 95% confidence interval [CI], 0.63 to 1.00). The primary outcome for the aspirin comparison occurred in 4.1% in the aspirin group and 4.7% in the placebo group (hazard ratio, 0.86; 95% CI, 0.67 to 1.10). The primary outcome for the polypill-plus-aspirin comparison occurred in 59 participants (4.1%) in the combined-treatment group and in 83 (5.8%) in the double-placebo group (hazard ratio, 0.69; CI, 0.50 to 0.97). The incidence of hypotension or dizziness was higher in groups that received the polypill than in their respective placebo groups.
So in essence, scheduled polypharmacy modestly reduced the prevalence of adverse cardiovascular outcomes – probably exactly what we might have expected. It remains to be seen if this approach is justifiable in the long term, as middle-aged participants transition into older age, the drawbacks of polypharmacy tend to become more pronounced. Longer term studies will be needed. See the details of the original research here.