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Durch
die in einer Tablette kombinierte Gabe eines Statins,
dreier unterschiedlicher Antihypertonika (in halber Standarddosierung),
von Folsäure und Aspirin könnte die Häufigkeit von Herzinfarkten
und Schlaganfällen um rund 80% gesenkt werden.
BMJ 2003;326:1419 (28 June)
A strategy to reduce cardiovascular disease by more than 80%
N J Wald, professor1, M R Law, professor1
1 Department of Environmental and Preventive Medicine, Wolfson
Institute of Preventive Medicine, Barts and the London, Queen
Mary's School of Medicine and Dentistry, University of London,
London EC1M 6BQ
Correspondence to: N J Wald n.j.wald@qmul.ac.uk
Objectives To determine the combination of drugs and
vitamins, and their doses, for use in a single daily pill
to achieve a large effect in preventing cardiovascular disease
with minimal adverse effects. The strategy was to simultaneously
reduce four cardiovascular risk factors (low density lipoprotein
cholesterol, blood pressure, serum homocysteine, and platelet
function) regardless of pretreatment levels.
Design We quantified the efficacy and adverse effects
of the proposed formulation from published meta-analyses of
randomised trials and cohort studies and a meta-analysis of
15 trials of low dose (50-125 mg/day) aspirin.
Outcome measures Proportional reduction in ischaemic heart
disease (IHD) events and strokes; life years gained; and prevalence
of adverse effects.
Results The formulation which met our objectives was:
a statin (for example, atorvastatin (daily dose 10 mg) or
simvastatin (40 mg)); three blood pressure lowering drugs
(for example, a thiazide, a {beta} blocker, and an angiotensin
converting enzyme inhibitor), each at half standard dose;
folic acid (0.8 mg); and aspirin (75 mg). We estimate that
the combination (which we call the Polypill) reduces
IHD events by 88% (95% confidence interval 84% to 91%)
and stroke by 80% (71% to 87%).
One third of people taking this pill from age 55 would benefit,
gaining on average about 11 years of
life free from an IHD event or stroke. Summing the
adverse effects of the components observed in randomised trials
shows that the Polypill would cause symptoms in 8-15% of people
(depending on the precise formulation).
Conclusion The Polypill strategy
could largely prevent heart attacks and stroke if taken by
everyone aged 55 and older and everyone with existing cardiovascular
disease. It would be acceptably safe and with widespread
use would have a greater impact on the prevention of disease
in the Western world than any other single intervention.
Full Text
Editorial I
Editorial II
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