Debating and Designing a Cure-All for Heart Disease
Experts Clash Over the Safety and Value of a Single Pill That Would Be Used to Treat Multiple Ailments

By Ranit Mishori
Special to The Washington Post
Tuesday, May 5, 2009

What if there were a pill that could prevent heart disease? Take one in the morning with breakfast and your arteries wouldn't clog, your heart muscles would stay vibrant and your ticker would just keep on ticking.

Too good to be true? Perhaps. But researchers are working on the recipe for just such a "polypill": Take the active ingredients of blood pressure drugs, mix in some cholesterol-lowering medication, a sprinkling of aspirin and, voila, the magic bullet for the at-risk population older than 50.

"These drugs are inexpensive, well-tested, and have been used individually for years," says family physician and former assistant surgeon general Douglas Kamerow. "Combining them into one pill could potentially make a big difference."

The idea has been gaining momentum since a study published in a British medical journal in 2003 suggested that such a pill could cut heart disease rates by as much as 80 percent.

A more recent study by Indian researchers looked at what happened when various experimental versions of an all-in-one pill were given to more than 400 people without heart disease and only one risk factor for the disease, such as smoking or high blood pressure. Their results, published last month in the Lancet, suggested that the pill "could be conveniently used to reduce multiple risk factors and cardiovascular risk." In other words, it caused no harm and did some good.

A polypill could affect the health of millions. Heart disease is the No. 1 killer of men and women around the world. To keep that killer in check, a lot of people are taking several different medications -- and sometimes forgetting to take them or to refill their prescriptions. One pill for everything heart-related could reduce so-called patient noncompliance.

But Washington Hospital Center cardiologist Patricia Davidson raises concerns: What would happen if patients react badly to one component of the pill or suffer some other negative side effect, the cause of which can't easily be identified?

Aspirin, for example, causes bleeding in some individuals, but the problems caused by other drugs might be harder to identify. "It would be difficult to replace the three or four drugs when trying to eliminate the drug with the side effects," Davidson says.

Others have raised questions about the dosage levels of each of the ingredients in a single pill, which cannot be as readily adjusted to suit individual needs.

Beyond these concerns is a philosophical one: Should we expect a pill for every problem? Sure sounds good, as Robert Bonow recently pointed out at the American College of Cardiology annual meeting in Florida.

"A single pill," said Bonow, a professor of medicine at Chicago's Feinberg School of Medicine at Northwesten University, "is exactly what people would love to have." But Bonow argues that medication should not be thought of as a means to "continue smoking . . . keep on eating what you're eating and not exercising."

"Aggressive public health campaigns to change unhealthy behavior should never be replaced with medication with potential side effects," Davidson warns.

Kamerow, who is chief scientist at RTI International, a research firm based in Research Triangle Park, N.C., dismisses such objections, saying they are "not a reason not to develop this pill."

According to Kamerow, the National Institutes of Health and other organizations are considering funding bigger trials to answer the most pressing questions, which the Lancet study could not: Can the pill lower death rates from heart disease? Can it prevent heart attacks?

It will be a while before we have enough solid evidence to suggest everyone older than 50 should take such a pill.

For now, doctors will have to continue dispensing the usual advice about lifestyle changes. As Bonow puts it, "We already have a polypill: It's called exercise."

Ranit Mishori is a family physician and faculty member in the Department of Family Medicine at Georgetown University School of Medicine. Comments:

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