Combination ‘polypill’ lowers the risk of major cardiovascular events, study finds

Older heart disease patients who took a combination “polypill” made up of three different medications had a lower risk of major cardiovascular events, according to a new study published Friday in the New England Journal of Medicine and presented at the European Society of Cardiology Congress in Spain.

Study authors led by Dr. Valentin Fuster, director of Mount Sinai Heart in New York City and general director of the Spanish National Center for Cardiovascular Research, looked at 2,499 patients in seven European countries who had a history of type 1 myocardial infarction in the past six months and were either over the age of 75 or a minimum age of 65 with at least one risk factor, such as diabetes or mild or moderate kidney dysfunction.

Half the patients were given the polypill that contained aspirin, ramipril and atorvastatin, while others received the usual standard of care. Patients were followed for a median of three years.

The researchers found 48 cardiovascular deaths in the polypill group and 71 in the usual-care group, meaning patients who took the polypill had a relative risk reduction of 33% for cardiovascular death. The polypill was also favorable in other measures studied in the trial, such as stroke or myocardial infarction.

The polypill and trial come after 15 years of work, Fuster said. He and colleagues decided that one of the main problems in medicine is the lack of adherence to the medication they’re meant to be taking, particularly in the cardiovascular field and most specifically in heart attack patients.

The American Heart Association lists taking medications as prescribed as one of the first things people can do to prevent another heart attack after having one.

“It seems that we have a tremendous kind of tool, which is a simple polypill, that actually is significantly better,” Fuster said. “Probably most of the reason is because of better adherence, because it’s a simple drug, with superb results and the impact is as good or even better than aspirin in the past.”

He said it was notable that the two curves — those who took a polypill and those who received standard care — separated from the beginning and continued to separate as the years go on, meaning there is a feeling that is the study went longer there would be “even more striking” results.

Fuster said that the polypill is something that could have a “very significant” impact on the general population.

According to the US Centers for Diseases Control and Prevention, someone in the US has a heart attack every 40 seconds. There are around 805,000 heart attacks in the country every year — 200,000 of those happening to people who have already had one.

There are some limitations to the research, including that the trial was not performed in a blinded manner and all patients were enrolled before the COVID-19 pandemic.