Volunteers sought to test 'polypill' for heart disease

Photo / The Aucklander

Medical researchers are calling for volunteers to test a four-in-one pill to combat New Zealand's biggest killer.

Hundreds of Aucklanders at risk of heart attack or stroke will be asked to test a new "polypill" capsule that it is hoped will dramatically reduce the incidence of cardiovascular disease.

The Auckland University researchers aim to recruit 600 patients for the trial, half of them Maori. They are looking for people who have had a heart attack or stroke or who have a 15 to 20 per cent risk of having one within five years.

Heart disease and stroke cause 40 per cent of the country's deaths and Maori suffer a disproportionately high risk. More than 200,000 New Zealanders are alive following a stroke or heart attack and a further 250,000 are at high risk of one.

Volunteers will be prescribed one of two kinds of polypill, or the same drugs dispensed as a traditional, potentially confusing cocktail of individual pills.

The test was to see whether combining the drugs into one cheaper tablet would "improve prescribing and improve adherence and therefore hopefully lead to a reduction in cardiovascular events", lead researcher Raina Elley said.

The results of the test will be combined with similar international trials.

At present, less than half of heart attack and stroke survivors in New Zealand, and less than a third of others in the high-risk group, are on the recommended "triple therapy" of aspirin plus drugs to lower cholesterol and blood pressure.

This treatment more than halves their risk. Some patients are allergic to one or more of the drugs; others find them complex to take or are deterred by the cost from multiple prescriptions.

A similar polypill was mooted by London researchers in the British Medical Journal in 2003. They predicted it could reduce heart attacks and strokes by more than 80 per cent if taken by everyone aged 55 and older and all those with existing cardiovascular disease.

Auckland University has already trialled a polypill against placebo pills for patients at moderate risk of heart attack or stroke. The results are expected to be published within weeks.

Researcher Rod Jackson said the idea of a polypill for low-risk patients had struggled because it wouldn't produce the big profits of new patented medicines, being a collection of long-established off-patent medicines.

"Moreover, it is likely to threaten new drug development because one polypill made up of three or four cheap generics is likely to be more effective and much cheaper than any new single drug on the market or likely to come on the market."

Another factor was doctors' concern it would be more difficult to adjust dosages of the component medicines and to identify which one might be the cause if a patient suffered a side effect.

Professor Shaun Holt, of Victoria University, who unsuccessfully promoted the "polypack" - pre-packaged sachets of the same pills as the polypill - said the polypill concept for low-risk patients collapsed last year after large studies of aspirin concluded the risk of harm from stomach bleeding outweighed the cardiovascular benefits, but he questioned these findings.

FOUR-IN-ONE

The polypill contains:

* Low-dose aspirin, to reduce blood-clotting.
* Statin, to reduce cholesterol.
* ACE inhibitor, to reduce blood pressure.
* Either beta blocker or thiazide, to reduce blood pressure.