Cardiovascular-Disease Prevention in a Pill?

One pill to prevent high blood pressure and high cholesterol? Yes, according to a new study from the United Kingdom.

Researchers at the Wolfson Institute of Preventive Medicine in London tested a polypill consisting of three blood pressure medications - amlodipine, losartan and hydrochlorothiazide - and simvastatin, a cholesterol-busting drug. They found that during a three-month period, a single polypill significantly lowered blood pressure and cholesterol levels in 84 study participants who were age 50 and older and had no history of cardiovascular disease.

The polypills contain standard doses of simvastatin and losartan and low doses of the other two medicines.

"The reductions were quite large, a 12 percent decrease in blood pressure and a 39 percent decrease in LDL cholesterol," said Nicholas Ward, a study co-author and director of the Wolfson Institute of Preventive Medicine.

Ward also developed the polypill used in this study. The reductions, he added, were in line with expectations based on the effectiveness of the individual medications.

The potential for this pill is huge, Ward said, because the data suggest healthy adults 50 and older can prevent heart disease, high blood pressure and stroke from ever happening.

"If we can prevent the heart attack and stroke in the first place, there won't be a second one to prevent," Ward said. "Most medical attention is now focused on treating people who already had a heart attack or stroke and preventing recurrence, and they use the same medications."

But the polypill isn't for everyone, he stressed.

The pill is for healthy adults because anyone taking certain medications, including blood pressure or cholesterol medications, might be at risk for adverse effects. The pill will also not reverse the physiological effects of smoking, obesity or other problems.

"It should also be used in conjunction with diet and exercise. This isn't an 'either, or' situation," Ward said.

Ward's isn't the only polypill ever developed. Several other studies focused on similar pills and found similar beneficial results.

Ward said there are trials underway that could eventually satisfy the scientific requirements of regulatory agencies in the United Kingdom.

Despite their promise, however, experts say polypills are a long way from being a treatment standard.

"With three blood pressure medications and a lipid-lowering agent in a pill, I would expect it to lower blood pressure and cholesterol, but I don't think it would get used much," said Dr. Carl "Chip" Lavie, medical director of cardiac rehab and prevention at the Ochsner Medical Center in New Orleans.

"Like a lot of things, I think it would get a little bit of use, but most clinicians wouldn't feel comfortable combining four medicines if we want to lower cholesterol and blood pressure," he added.

Current guidelines, he explained, call for the use of two blood pressure medications to start with if needed, and few doctors would consider using three at one time.

Theoretically, it makes sense that the polypill works, but there is nowhere near the amount of evidence needed to prove it should make the jump from experimental to clinical use.

"If it were proven to be safe, worked over the long term and did lower cardiovascular risk and mortality," Lavie said, "then we'd be doing it, but we're not even close to having evidence for that."