‘Polypill’ Reduces Risk of Repeat Heart Attacks

For years, doctors have prescribed a standard regimen of medications to help heart attack survivors avoid another serious cardiovascular event. And for just as long, many patients have struggled to keep up with all of these pills.

Results of a new clinical trial suggest that the solution may be a so-called “polypill” containing three of these commonly prescribed medications: aspirin to prevent clots that lead to heart attacks; an angiotensin-converting enzyme inhibitor (ACE inhibitor) to control blood pressure; and a cholesterol-lowering statin.

For the trial, researchers randomly assigned almost 2,500 heart attack survivors to take either a three-drug polypill or a standard drug regimen with similar medications, each prescribed separately. After about three years of follow-up, patients on the polypill were 33 percent less likely to die of cardiovascular-related causes than people taking a standard regimen of multiple daily pills, according to study recently published in The New England Journal of Medicine.

Researchers offered a pretty simple reason why patients had better survival odds with the polypill. More people took all of their prescribed medications when they could do this by swallowing a single pill, trial leader Valentin Fuster, MD, PhD, director of Mount Sinai Heart and physician-in-chief of the Mount Sinai Hospital in New York City, said in a statement.

“Although most patients initially adhere to treatment after an acute event such as a [heart attack], adherence drops off after the first few months,” Dr. Fuster said. “Our goal was to have an impact right from the start, and most of the patients in the study began taking a simple polypill in the first week after having a heart attack.”

Over the course of the study, people on the polypill were 24 percent less likely to experience one of four outcomes: a death from cardiovascular causes, a nonfatal heart attack, a nonfatal stroke, or surgery to unclog a blocked coronary artery.

This was in a population of people at high risk for these outcomes. Slightly more than half of the study participants had a history of smoking, 57 percent of them had diabetes, and 78 percent had high blood pressure.

Because all of the patients in the study were heart attack survivors, the results offer insight into the polypill only for what’s known as secondary prevention — or intervention to avoid a repeat heart attack or prevent other cardiovascular events. The trial didn’t examine whether the polypill can benefit people who haven’t had a heart attack but have some risk factors such as high blood pressure or elevated cholesterol.

Even so, half of heart attack survivors don’t take all of the medications they should to prevent another life-threatening cardiovascular event, according to the American Heart Association (AHA). Taking all of the drugs recommended after a heart attack could cut the risk of heart-related deaths by up to 80 percent, the AHA notes.

One study that looked at compliance with prescribed drug regimens with a more forgiving approach looked at how many heart attack survivors took all of their prescribed medicines at least four out of every five days. And just 43 percent of patients managed this. When they did, they were 19 percent less likely to have a repeat heart attack, stroke or other serious cardiac complication.

Many patients don’t take medication as directed after a heart attack because they forget, don’t know what to do after they accidentally miss a dose, or feel ambivalent about taking the drugs, one study of medication compliance suggests. Costs can also play a role, as can depression, another study suggests.

The polypill tested in the trial, marketed as Trinomia in Europe, isn’t available in the United States. It contains aspirin (100 milligrams, or mg), the ACE inhibitor ramipril (2.5, 5, or 10 mg), and the statin atorvastatin (20 or 40 mg).