International study shows cardiac patients more likely to take their drugs if they're packaged together
TUESDAY, Sept. 3, 2013 (HealthDay News) -- People dealing with chronic conditions like heart disease often have trouble keeping up with the fistfuls of medications needed to maintain their health.
Now scientists have tested a potential solution that might just work: a "polypill" combining several different medications.
A new international study found that heart patients are much more likely to regularly take aspirin and drugs for cholesterol and blood pressure if they are all stuffed into a single pill.
"The general advantage is that everything is all in one medication," said Dr. Gerald Fletcher, a spokesman for the American Heart Association, who was not involved in the study. "Patients who have to take a dozen pills at a time tend to have a hard time remembering to take them."
Heart patients can reduce their risk of heart attack or stroke by more than half if they take a combination of blood pressure medication, statin drugs to lower cholesterol, and aspirin to break up blood clots.
Despite this, only about half the people with cardiovascular diseases in prosperous countries take all the recommended preventive medications. In developing countries, only 5 percent to 20 percent keep up with their prescriptions.
The new study, published in the Sept. 4 Journal of the American Medical Association, involved 2,004 people with cardiovascular disease in the United Kingdom, Ireland, the Netherlands and India. Most of the patients in the study had already had a heart attack or stroke, while the rest were considered at high risk based on factors such as high blood pressure, cholesterol and smoking.
Doctors randomly assigned the participants either the polypill -- which had an antiplatelet (to prevent clots), a statin and a blood pressure-lowering drug -- or their normal combination of medicines.
After about 15 months, the number of patients using the polypill and keeping up with their medications was more than 86 percent, compared to just under 65 percent of those taking the individual drugs.
The improvement was most notable for patients considered least likely to keep up with their medication regimen. That rate went from about 23 percent adherence up to 77 percent.
"That's outrageous, in terms of improvement," said Dr. David May, chair of the board of governors for the American College of Cardiology.
The polypill group also had lower blood pressure and cholesterol, compared with those taking the individual medications.
The idea of a preventive polypill has been kicking around for some time, May said, but this is the first study he had heard of comparing that kind of pill to existing treatments.
"This particular study I like because they're comparing it to regular therapy with standard agents," May said. "We're not just comparing the polypill to nothing. They're actually comparing it to standard therapy."
There are some drawbacks, however.
"What do you do when a guy gets a rash? You now have to deal with the issue of which component might be causing the difficulty," May noted.
The polypill also reduces doctors' ability to tweak the amount of medication a person is taking if, for instance, more blood pressure control is needed, he added.
"There are individuals who feel very strongly this ought to be the statin we use in this environment or that environment," May said.
And there may be potential problems related to the timing of doses, Fletcher noted.
"Some medications need to be taken at night. In this particular study, the statin drug and the blood pressure drug usually need to be taken at night," he said. "Antiplatelets are often taken in the morning. That's a slight disadvantage for the polypill."
On the other hand, Fletcher said bringing such a pill to the U.S. market could be easy, given that generics were used in the study.
"If there are only two components in a polypill, such as statin and aspirin, it could get on the market faster, probably at least a year or more," he added. "The more complex the pill, the longer it will take."
May noted in addition that patients' drug costs could be reduced if they are prescribed a single pill containing several different generic medications.
"The simplification of the delivery of care we provide to our patients is a significant part of the improvement we can gain by this type of strategy," May said. "Oftentimes we become enamored with the idea of how much improvement we get with this or that medication, on top of the other drugs a patient has been prescribed. The short answer is, if they don't take it, you don't get any improvement."
For more on cardiac medication, visit the American Heart Association (http://www.heart.org/HEARTORG/Conditions/HeartAttack/PreventionTreatmentofHeartAttack/Cardiac-Medications_UCM_303937_Article.jsp ).
SOURCES: Gerald Fletcher, M.D., professor of medicine in cardiology, Mayo Clinic College of Medicine, and spokesman, American Heart Association; David May, M.D., chair, board of governors, American College of Cardiology; Sept. 4, 2013, Journal of the American Heart Association