Combination Pill Reduces Heart Disease Deaths

People who take a “polypill” containing a combination of three heart drugs are more likely to stay on their medicine and less likely to have a heart attack.

Heart disease is the biggest killer in the United States, responsible for 1 in every 5 deaths. While effective medications are available to prevent heart attacks and other heart disease complications, only about half of people who are prescribed these drugs actually take them.

A large European study published in The New England Journal of Medicine (NEJM) found that people who take a “polypill” containing a combination of three heart drugs are more likely to stay on their medicine and less likely to have a heart attack or die from heart disease.   

Polypills aren’t available for sale in the United States yet, but they might one day be a promising way to improve medication adherence.

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What is a polypill?

A polypill combines three or more heart disease medicines into one pill. Although the exact medicines have varied from study to study, these pills typically contain:

• Aspirin
• Cholesterol-lowering statin medication
• Blood pressure medication

Combining these drugs into one dose simplifies the process of taking heart medications. The hope is that polypills will help people keep taking their treatment to protect their heart. So far, research seems to support that idea.

Polypills for heart disease prevention

A study called Secondary Prevention of Cardiovascular Disease in the Elderly (or SECURE) randomly assigned nearly 2,500 people who’d had a heart attack within the past six months to take either a polypill or their usual medications. Everyone in the study was over either age 65 or 75 but with cardiovascular risks such as diabetes or kidney disease.

The polypill used in the study contained:

• Aspirin
• Ramipril (Altace), a blood pressure medication
• Atorvastatin (Lipitor), a cholesterol medication

The researchers discovered lower heart-related events and deaths in the polypill group. In the usual care group, nearly 13 percent of people had a heart attack, stroke, needed surgery to open a blocked artery, or died from cardiovascular disease, compared to 9.5 percent in the polypill group. Heart disease deaths alone were 33 percent lower in the polypill group.

The authors at least partly attributed the better outcomes in the polypill group to more people taking their medication as prescribed. More than 70 percent of people who took a polypill stayed on their medication, compared to fewer than 63 percent in the usual care group.

This isn’t the first study to find a benefit from polypills. Another analysis of three large trials including more than 18,000 participants found that combination treatment reduced heart disease, heart attack, stroke, and deaths from heart disease compared to usual treatment.

What are the risks?

One concern with the polypill has been that combining several drugs into one might increase side effects, but that hasn’t been the case in studies done so far. About the same number of people in the NEJM study experienced side effects such as bleeding and dizziness with the polypill as with other treatments.

Potentially the biggest downside to combination regimens is the fixed doses of each medication. That prevents doctors from adjusting the dose of any one drug in the pill, which is often necessary to find the best individualized dose.

What you can do

Polypills aren’t yet available in the United States to simplify your heart disease medication regimen. Until one does become available, here are a few tips to help you stick with your treatment plan:

• Get a pillbox or smart pill organizer to sort your medications for you.
• Keep a daily calendar or chart and write a checkmark on it after each dose you take.
• Ask your partner, another family member, or a good friend to remind you when it’s time to take your heart medicine.
• Have your pharmacy automatically renew each prescription so you won’t have to remember.
• Take your heart medications as part of other routines, like brushing your teeth at night or eating breakfast.

If you have side effects from any of your heart medications, don’t just stop taking them: Check with your cardiologist or primary care doctor.

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