After crunching a lot of numbers about heart disease and drug effectiveness, a group of researchers last year suggested that doctors should prescribe a "polypill" to heart patients. This single pill had 6 different drugs to prevent heart disease, and the doctors behind the idea said, in the British Medical Journal, that the pill would cut deaths caused by heart trouble by a whopping 80 percent. The only trouble was the pill was a fantasy, some wishful medical thinking. It didn't exist.
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This week another group proposes something much more realistic: an inexpensive, 4-drug combo cocktail. This is a treatment given after disease crops up, not a preventive pill. But it's remarkably effective. The combo, given to heart attack patients, reduced their risk of dying by 90 percent for six months after leaving the hospital. Even those people who got two or three of the drugs had a much lower death risk than those who didn't get any, scientists report in the current issue of Circulation. "We knew that each of these kinds of drugs works pretty well alone," University of Michigan cardiologist Debabrata Mukherjee noted in a prepared statement to the press, "but we never expected that together they would be this powerful."
These are not exotic medications. The "fab four" includes statins, to lower cholesterol; aspirin and other antiplatelet drugs to reduce blood clots; ACE inhibitors to lower blood pressure; and beta-blockers, which ease the heart's workload. There are national guidelines, published by the American Heart Association and the American College of Cardiology, that recommend these drugs–individually or in combination–for patients who have had heart attacks or unstable angina. But when the researchers examined the hospital records of about 1,200 such patients, they learned that not every patient eligible for a beneficial drug actually got it. Indeed, 40 percent of good candidates for ACE inhibitors went without; 18 percent didn't get any beta-blockers, 16 percent didn't get statins, and 5 percent were not even prescribed aspirin.
That's rather shocking when you consider what good the medications can do. The researchers divided these patients into four groups based on their drug prescriptions, ranging from those who left the hospital with none of the desired four to those who had prescriptions for all of them. The group with all four had the big risk reduction of 90 percent compared with the empty-handed group. Even patients who got two or three drugs dropped their risk by around 80 percent. Those improvements on multiple drugs are even better than studies of the individual drugs suggest, so the researchers think the combinations have a synergistic effect: one drug boosts the beneficial properties of another.
These prescriptions are not going to break the bank. Researchers think that all four, as generics, will cost less than $50 per month, even without insurance copayments or reimbursement. The low price, by the way, is probably one reason pharmaceutical companies aren't rushing to develop a "polypill": All these drugs are cheap as they are, and unprotected by patents, so there's little money to be made by lumping them together. All this adds up to some very strong reasons for heart patients to have a firm talk with their physicians and make sure they are getting the medications that will help them the most.
