Cheap combo pill cuts heart and stroke risks

Stronger evidence

LONDON, Aug 24, (Agencies): A cheap daily pill that combines four drugs cut the risk of heart attacks, strokes and heart failure in a large study, suggesting it could be a good way to help prevent heart problems especially in poor countries.

The pills contained two blood pressure drugs, a cholesterol medicine and aspirin. Many people can’t afford or don’t stick with taking so many medicines separately, so doctors think a polypill might help. A previous study testing one in India found it lowered cholesterol and blood pressure. The new study is much larger and gives stronger evidence because it tracked heart attacks, strokes and other problems – not just risk factors.

It involved about 6,800 people in Iran, ages 50-75, some with previous heart problems and others without them. All got advice on healthy lifestyles and half also were given polypills. After five years, 6% of those in the pill group had suffered a heart attack, stroke or heart failure versus 9% of the others. That worked out to a 34% lower risk with the polypill, and a 22% lower risk after researchers took into account other heart drugs that participants were taking.

People who took the polypill most faithfully, at least 70% of the time, had even bigger reductions in heart risks.

The benefit mostly seemed to come from lowering cholesterol; blood pressure didn’t significantly change. Side effects were similar in both groups. Some who developed a cough while on the polypill were switched to another version that substituted one of the four drugs. All of the drugs are cheap generic medicines now.

Results

Results were published Thursday in the British journal Lancet. The study was paid for by Tehran University of Medical Sciences, a foundation and Alborz Darou, the company that makes the polypills.

“This is an important step in the right direction,” said Dr Salim Yusuf of McMaster University in Canada, who leads another polypill study expected to finish next summer. “This could be used in every sensible country where we want to save lives.”

One study leader, Dr Tom Marshall of Britain’s University of Birmingham, said the results show the polypill is a “viable strategy” to prevent heart disease in developing countries.

“It’s much simpler to give people one medication that manages a couple of risk factors at the same time,” he said.

Marshall said, however, that the benefits would be minimal for people who already have access to good health care.

“But if you’re in a system where people don’t have great access, then this is a significant advantage,” he said.

Dr Amit Khera, director of preventive cardiology at Southwestern Medical School in Texas who had no role in the study, said he expected that polypills would start to be used more widely in the next few years if they’re shown to work in other groups besides the people of central Asian ancestry tested in the Lancet study.

“The biology is different in different populations, so before we apply it to all of India or all of North Africa, we need to know these polypills are actually safe in these populations,” he said.

GENEVA:

Also:

Ebola appears to be under control in the city of Goma in Congo but it has flared in other parts of the country, where aid workers are combating insecurity and disinformation on social media, the World Health Organization (WHO) said on Friday.

The latest infections include the mysterious case of a woman in her 70s with no known history of travel or visitors, said Dr Michael Ryan, head of WHO’s health emergencies department.

The woman, in the remote village of Pinga in the northeast of Democratic Republic of Congo, may have caught the deadly haemorrhagic fever by eating bushmeat or from another animal source, he said.

Nearly 3,000 cases have been confirmed, including 1,965 deaths, since the outbreak began a year ago, the second biggest toll in the disease’s history, the latest figures show.

“Over the last couple of weeks we have seen worrying extensions of the disease ... we have had a cluster of cases in Mwenga, to the south of Bukavu, we have a case in Pinga – which is very difficult and inaccessible area to the northeast of Goma,” Ryan told a news conference.

The case in Pinga, announced earlier this week by the health ministry, is in a militia-controlled territory of Walikale, hundreds of kilometres from where previous cases near the border with Uganda and Rwanda occurred.

“The challenge is this case has no apparent epidemiologic links to other cases or no recent travel outside or visitors from outside,” Ryan said.

“We obviously need to ensure that we haven’t had another spillover from the forest or from a zoonotic or animal source. That is currently under investigation and there is further testing going on and genetic sequencing,” he said.

Goma, a lakeside city of nearly 2 million people on the Rwandan border, has been on high alert for weeks after a gold miner with a large family contaminated several people before dying himself last month.

There are currently no cases in Goma, where four cases have been recorded, without further spread, Ryan said.

“We haven’t seen secondary transmission in Goma – and it represents a huge credit to the teams on the ground in a city the size of Goma that we are approaching the end of the observation period for all of the contacts with no evidence of further transmission within the metropolitan area,” he said.

Monitoring of 232 contacts of infected people will end in coming days, he said.