Combining multiple heart disease drugs into a single “polypill” can help patients lower bad cholesterol and blood pressure, boost medication adherence, and reduce the risk for heart disease and death, according to a meta-analysis of recent clinical trials published in Nature Medicine.
The hardening and narrowing of arteries from the buildup of cholesterol and fat can block blood flow to vital organs and plays a key role in heart attack, stroke and other forms of heart disease, and is a leading cause of death worldwide, according to the National Institutes of Health.
Because treating this buildup of plaque often requires multiple drugs targeting lipid levels and blood pressure, combining multiple drugs into a “polypill” has become an attractive option, said Nilay Shah, ’14 MD, ’14 MPH, ’20 GME, assistant professor of Medicine in the Division of Cardiology and of Preventive Medicine in the Division of Epidemiology, who was a co-author of the study.
“The regimens for both primary and secondary prevention of heart disease – meaning prevention of heart disease in people who don’t have it yet and preventing additional heart disease in people who have experienced an event – have started to become a little bit complicated. It’s often hard for patients to take multiple different types of medication or multiple different medications. This is where the idea of a fixed-dose combination or polypill came about.”
In the current study, Shah and his collaborators analyzed the results from 26 previous randomized clinical trials which included polypills with at least one blood pressure-lowering drug and one lipid-lowering drug.
After reviewing data from more than 27,000 study participants, investigators found that polypill therapies resulted in lower LDL (“bad”) cholesterol, lower blood pressure, and higher rates of medication adherence, according to the study.
However, participants who took polypills also experienced more adverse effects, the study found.
Overall, polypill therapies lowered the risk of all-cause mortality by 11 percent, according to the study findings.
“Not only do we see the participants’ measures of heart health improve, like blood pressure and cholesterol, but we also see higher adherence to the recommended course of medication, and polypills result in reduction in the risk of death and heart disease events,” Shah said.
Because some polypill therapies are already commercially available and FDA-approved, the findings can help clinicians build medication regimens that are easier for patients to stick to, Shah said.
Moving forward, Shah and his collaborators will work to understand how polypill therapies can best be implemented in diverse clinical settings, he said.
“Now that we know that fixed-dose combination therapies are effective at reducing the risk for heart disease, how do we get them to the people who benefit from them?” Shah said. “How do we make sure they’re available from manufacturers in an equitable way so that they’re affordable to people and covered by insurance? How do we transition away from individual medications and get clinicians to use fixed-dose combinations and prescribe them to their patients?”