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Single combo 'polypill' could save more NZers from heart attacks

Fuseworks Media
Fuseworks Media

More people would take their heart medications if their pills were combined into a single ‘polypill’, potentially saving hundreds more New Zealanders from heart attacks and strokes.

A polypill called Trinomia containing the three standard drugs internationally prescribed to prevent recurrence of cardiovascular disease - aspirin, a statin, and a blood pressure lowering medication - has already been approved by Medsafe, in 2017. But so far, PHARMAC has not funded it.

In an article published in the New Zealand Medical Journal [Friday 20 September, 2019], University of Auckland and Otago researchers argue funding of a polypill for the prevention of heart attacks and strokes in people with a history is ‘long overdue’ in a country where these diseases are the leading cause of death, accounting for one in three deaths annually.

The World Health Organisation first proposed a polypill for this use in 2001 (polypills for other conditions, including HIV and diabetes, are already in use in Aotearoa New Zealand). Since then, the researchers write, powerful evidence has amassed that such a polypill is safe, effective, more likely to be taken and cheaper than multiple pills.

"We know that people are missing their meds. We’ve got the evidence to show that if we combine the medication into a single pill it does improve people’s use of it, so we should be making it available," says lead author, Dr Vanessa Selak, a senior lecturer in the Department of Epidemiology and Biostatistics in the University’s School of Population Health.

People who have already had a heart attack, stroke or related event are at a raised risk of having another one. Heart medications can lower that risk, but the evidence shows many people are not regularly taking their medications: recent NZ data indicates that only 57 percent are receiving all the preventative medications. A 2011 international survey found only 44 percent of people with a heart disease history in high income countries reported consistently taking their heart medications.

"People may not be prescribed the medications in the first place, or maybe only one or two of them, or not at the right dose," says Dr Selak. "Also sometimes even if people get a prescription, they may not be able to afford three pills, which costs $15 for most people, but perhaps they could afford $5 for one polypill. And some people find that having a whole lot of meds to take makes it harder to take them."

One University of Auckland-led clinical trial, conducted in Auckland and Waikato, found that almost twice as many participants given polypills took all of their recommended heart medication compared to participants given the medication as separate pills (81 percent versus 46 percent), and the improvement held for both Māori and non-Māori.

Polypills could also potentially help reduce the six to seven-year life expectancy gap between Māori and Pacific people and other New Zealanders, because heart disease is a major driver for this gap.

The authors say that a polypill is no panacea - it may not contain the right components or ratio of doses for certain patients, and it may not be suitable in the period immediately after a heart attack or stroke, when doctors need to repeatedly tweak medications. And beyond getting the medication right, much more needs to be done to tackle heart disease, like reducing risk factors such as smoking and obesity.

But for people who are currently taking nothing, or taking their medications erratically, a polypill offers a simple, cheap tool for improving their health.

Dr Selak: "You could see it as a debate between the ‘perfect’ and the ‘possible’: if you can’t get the ‘perfect’ doses and adherence for an individual patient, how about giving them a chance for the ‘possible’ with a polypill? If this makes it easier for people to take and they’re more likely to take it, why not give it to them?"

The article’s other authors were Professors Bruce Arroll, Chris Bullen, Rob Doughty, Matire Harwood, Research Fellow Dr Corina Grey, all from the University of Auckland, and University of Otago Associate Professor Sue Crengle.

Journal article: New Zealand Medical Journal: The strong case for government funding of a polypill for the secondary prevention of cardiovascular disease in New Zealand

Key points: Cardiovascular disease (CVD) is one of the major causes of mortality, morbidity and inequities globally and in New Zealand.

A major strategy to reduce the burden of CVD is preventive medication (aspirin, statins and blood pressure-lowering therapy).

Recent NZ data indicates that only 57 percent of people who have already had a CVD event (such as a heart attack or a stroke) are receiving all CVD preventive medications.

One way to improve access to medications is by combining them into a single pill or capsule (a ‘polypill’).

There is considerable international and NZ evidence supporting the safety and effectiveness of polypills for people who have already had a CVD event.

Despite this evidence, CVD preventive polypills have not yet been funded by PHARMAC.

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