A magic bullet for heart disease?

A single pill made up of different drugs and folic acid could reduce heart attacks and strokes by more than 80 per cent, suggest researchers in this week's British Medical Journal​. Heart attacks, stroke, and other preventable cardiovascular diseases currently kill or seriously affect half the population of Britain.

Professors Nicholas Wald and Malcolm Law propose that a single pill containing six active components - aspirin, a cholesterol lowering drug, three blood pressure lowering drugs at half standard dose, and folic acid - taken daily by everyone from age 55 would have a huge impact on the prevention of disease in the Western world.

Their radical strategy is based on evidence from over 750 trials involving 400,000 participants. Each component of the 'Polypill' would reduce one of four cardiovascular risk factors - high blood cholesterol, blood pressure, blood homocysteine levels, and platelet function, making it suitable for many people with existing high blood pressure, heart disease or diabetes.

Folic acid has been shown to reduce levels of homocysteine in the blood, thought to be a marker for heart attack risk. However studies have found no link between blood folate levels and death from heart disease or risk of heart attack, and the understanding of the role of folic acid in heart health is far from conclusive.

Trials of the 'polypill' to assess its safety and efficacy will likely take several years, but the authors suggest that the pill would be taken without a medical examination or measurement of risk factors as treatment would be effective whatever the initial levels of the risk factors.

There is much to gain and little to lose by the widespread use of these drugs, they add, arguing that it is time to recognise that in Western society the risk factors are high in all of us, so everyone is at risk.

In an accompanying editorial, Dr Anthony Rodgers supports the bold proposal, arguing that despite widespread perceptions, these medications are extremely safe and well tolerated - new problems seem unlikely since they have been studied so extensively and used so often together.

However Bill Sardi, of Knowledge of Health, based in California,US, argues in a different article that it is "obvious that a well-designed multivitamin containing magnesium, potassium, coenzyme Q10, folic acid, vitamin B12, vitamin B6, vitamin C in ample amounts may equal or exceed the proposed benefits of the polypill and be more affordable in third-world countries where the polypill is suggested for use".​

He continues: "Many heart attacks, in particular the sudden-death variety, are prompted by a shortage of magnesium, which is a heart muscle relaxant. The omission of magnesium from the polypill ingredients is a major oversight."​

Indeed, some of the ingredients in the polypill are needed just to counter side effects and deficiencies caused by the cure-all pill itself, concludes Sardi, pointing out that aspirin depletes the body of folic acid.