Single pill strategy to beat cardiovascular diseases

Single pill strategy to beat cardiovascular diseases

Subject : Science and technology

Section: Health

Context:

World Health Organization (WHO) added three fixed-dose combinations of cardiovascular medicines or polypills to its revised Model Lists of Essential Medicines 2023.

What is Cardiovascular disease (CVD)?

A group of disorders that affect the heart and blood vessels. It includes various conditions that can lead to impaired blood flow, damage to the heart muscle, or other abnormalities in the cardiovascular system.

What are common types of CVD?

1. Coronary Artery Disease (CAD) – Narrowing or blockage of coronary arteries.
2. Hypertension (High Blood Pressure) – Consistently elevated blood pressure levels.
3. Stroke – Sudden interruption of blood flow to the brain.
4. Heart Failure – Inability of the heart to pump blood effectively.
5. Arrhythmias – Abnormal heart rhythms (fast, slow, irregular).
6. Valvular Heart Disease – Problems with heart valves.
7. Peripheral Artery Disease (PAD) – Narrowing or blockage of leg arteries.
8. Aortic Aneurysm – Abnormal widening of the aorta.
9. Congenital Heart Defects – Structural heart abnormalities from birth.
10. Cardiomyopathy – Weak or thickened heart muscle.

What are the common medications used for CVD?

1. Statins: Lower cholesterol levels to reduce heart attack and stroke risk.
2. Beta-Blockers: Lower blood pressure and reduce heart workload.
3. ACE Inhibitors: Relax blood vessels and lower blood pressure.
4. ARBs (Angiotensin II Receptor Blockers): Lower blood pressure by blocking angiotensin II.
5. Calcium Channel Blockers: Relax blood vessels and reduce heart workload.
6. Diuretics: Eliminate excess sodium and water to reduce fluid buildup and blood pressure.
7. Antiplatelet Agents: Prevent blood clot formation, used in heart attack and stroke prevention.
8. Anticoagulants: Prevent blood clot formation, used in atrial fibrillation and thrombosis management.
9. Nitrates: Relax blood vessels, relieve angina, and improve blood flow to the heart.
10. Digoxin: Strengthen heart contractions and control heart rate in certain conditions.

What are the challenges with current medications?

• Adherence – Ensuring patients consistently follow prescribed medication regimens.
• Side Effects – Managing potential adverse reactions to CVD medications.
• Drug Interactions – Addressing issues when multiple medications interact.
• Cost – Affordability and access to expensive CVD drugs.
• Resistance – Development of reduced drug effectiveness over time.
• Individual Variability – Different responses to CVD drugs among patients.
• Polypharmacy – Managing multiple medications for patients with various risk factors.
• Access and Availability – Ensuring widespread availability of essential CVD drugs.
• Education and Awareness – Raising awareness about CVD medications and their benefits.
• Patient Education – Educating patients about medications, dosage, and adherence.

What is polypill?

• A polypill refers to a single pill that combines multiple medications or active ingredients into one formulation.
• Polypills are designed to target cardiovascular risk factors, such as high blood pressure, high cholesterol levels, and aspirin for antiplatelet effects.

How do polypills overcome challenges posed by traditional medications?

• Simplifies treatment by combining multiple medications into a single pill.
• Improves patient adherence to medication regimens.
• Addresses multiple risk factors simultaneously, particularly for cardiovascular health.
• Can lead to cost savings in manufacturing and distribution.
• Streamlines healthcare delivery for providers and patients.
• Offers preventive benefits by including medications with preventive effects.
• Reduces the chance of drug interactions since the medications are formulated together.
• Can be customized to target specific health conditions or risk profiles.
• Potential for wider use in public health interventions to address population health issues.
• Particularly beneficial in low-resource settings or areas with limited access to healthcare.
• Provides a standardized treatment approach, ensuring consistent dosing for all patients.

What are the limitations of polypills?

• Limited customization for individual patient needs.
• Increased risk of side effects due to combining multiple medications.
• Difficulty adjusting doses of individual medications.
• Reduced flexibility in treatment options.
• Potential for drug interactions despite efforts to minimize them.
• Not all medications or medical conditions may be suitable for combination in a polypill.
• Difficulty in stopping specific medications without discontinuing the entire polypill.
• Long-term safety and efficacy data are limited.
• Complex regulatory approval process.

What research led to their inclusion in WHO list?

• Dr. Salim Yusuf, a cardiologist and researcher at McMaster University, Canada, has spent over two decades building clinical evidence supporting polypills’ efficacy..
• Along with co-researchers Wald and Law from the U.K., proposed the concept of a polypill combining multiple blood pressure lowering drugs, a statin, and aspirin in the early 2000s.
• Worked on formulating different polypills and conducting large trials involving over 25,000 people.
• The trials demonstrated that the polypill reduced the risk of future heart attacks and strokes by approximately 40% to 50%

What is Polycap?

• A four-drug combination (simvastatin + ramipril + atenolol + hydrochlorothiazide) with acetylsalicylic acid (aspirin).
• Included in the WHO’s Essential Medicines List.
• The Indian Polycap Study conducted between 2005 and 2019 established the safety and efficacy of the polypill, showing a 40% reduction in heart attacks, strokes, and deaths from heart attacks.
• Despite 20% to 30% of participants stopping the medicine midway through the trial, the polypill still demonstrated significant benefits.