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| Archive : Winter 2007 |
RADICAL VISION:
A cocktail of cardiovascular drugs // Recommended for everyone over 55 // No prescription necessary // No need for a doctor’s oversight // The brainchild of overly ambitious would-be pioneers, or truly
the world’s next wonder drug?
The Polypill
 By Rachael Moeller Gorman |
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R ichard Smith, editor of the prestigious British Medical Journal, opened his June 28, 2003, editorial with this teaser: “It’s perhaps more than 50 years since we published something as important as the cluster of papers from Nick Wald, Malcolm Law and others.” Intrigued readers pored over the papers, which described an approach that “would have a greater impact on the prevention of disease in the Western world than any other single intervention.”
The intervention turned out to be a cardiovascular drug with an unusual strategy of delivery: Wald and Law envisioned that everyone over age 55, the population segment accounting for 96% of all deaths from coronary artery disease and stroke, would take the pill every day for the rest of his or her life. If all complied, 88% of heart attacks and 80% of strokes would be prevented, said the authors, who also opined that physicians need not be involved.
Wald and Law called their drug the Polypill, a combination of several powerful cardiovascular medications—a statin, an ACE inhibitor, a beta-blocker and a thiazide—as well as aspirin. And if in 2003 the Polypill was just a theory, last September at the World Congress of Cardiology in Barcelona, World Heart Federation president Valentin Fuster announced that a version of the pill could be introduced in Spain by 2009, while investigators in New Zealand and Australia are about to begin trials on alternate versions of the pill.
After the BMJ published the papers, physicians showered the journal with letters of concern—not only about whether the Polypill would work but also about whether it would even be desirable. “How nice…to live in a Polypill world,” wrote German scientists. “One for heart disease, one for mood, and maybe even one for finding the right partner.”
The Polypill idea is radical, in part because physicians generally prescribe powerful medications to healthy people only if they are at extremely high risk. But proponents contend that anyone living in the Western world today falls into the high-risk category and needs to reduce each of many cardiovascular-disease risk factors, not just the one or two surpassing some arbitrary threshold. Otherwise, those proponents warn, many of us could become part of the third of the population who die from an almost completely preventable disease.
Polypill fans or not, most physicians agree on one thing: Dying of a heart attack is not natural. “This is a disease we manufactured through the way we live,” says David Wald, a London cardiologist who is part of the Polypill team with his father, Nicholas, and Malcolm Law.
Cardiovascular disease is the No. 1 killer in the United States. In part, that prevalence stems from our lifestyles. We commute long distances to office jobs that allow no time for exercise and lead us to rely on processed or fast foods packed with salt, saturated and trans fats. As a result, our cholesterol and blood pressure readings are often too high to be healthy.
Nicholas Wald and Law propose addressing this problem with a new approach. What if we were to not focus exclusively on what has been a losing battle against our culture, and instead begin to address each of the many factors that contribute to heart disease before it becomes a problem? What if all risks—high blood pressure, cholesterol, homocysteine (an amino acid that has been linked to cardiovascular disease) and poor platelet function (clumped platelets can lead to a heart attack or stroke)—were reduced even in those whose test results put them in the normal range? “There’s no evidence of a threshold for these risk factors,” says David Wald. “There’s benefit in changing their level in everybody.”
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Illustrations by Christoph Niemann |
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