The NHS can prevent thousands of heart attacks and strokes with a single “polypill” strategy

According to UCL scholars, the NHS can prevent thousands of more heart attacks and strokes each year by offering statins and three blood pressure-lowering drugs to everyone, a 50-year-old, via one “polypill.”

With opinion BMJThe author argued that the Polypill programme in Labour's commitment to preventing illness rather than treating illness could become a “flagship strategy.” The program uses age only to assess eligibility, focusing on disease prevention rather than disease prediction.

They said such strategies should replace the NHS health check, a five-year assessment of people aged 40-74 who have been prescribed cholesterol-lowering statins if they are deemed at a high risk of heart attacks or stroke or if blood pressure is lowered when blood pressure is lowered.

According to the author, the new program only requires 8% of people over 50 to receive a polypill offer to achieve greater health benefits than NHS health checks.

The author pointed to a groundbreaking paper in 2003, estimating that polypills over the age of 55 can prevent approximately 80% of heart attacks and strokes. They argued that the conclusion was supported by clinical trials that have occurred over the years in several countries.

NHS health checks aren't working very well. The intake is low, with only 4 in 10 people receiving reservation offers. Many people who benefit from medication are not prescribed it.

Furthermore, our complex risk prediction tools are not very effective. They don't really predict who will have a heart attack or stroke. This is because most heart attacks and strokes occur in people at average levels of risk.

Now is the time to improve prevention. A population-wide approach can prevent more heart attacks and strokes than the current strategy of targeting only a more limited group. ”

Aaron Hingorani, co-author, Professor UCL Institute of Health Informatics

Professor Hingorani added: “The Polypill program is a simple, effective, potentially low-cost strategy. The drugs are patented. The evidence for many years is that statins are low-risk and by combining three low-dose drugs, it reduces the side effects of these drugs and increases the profits.

“People can receive a Polypill offer when they turn 50. No health checks or tests are required, but further evaluation via online surveys may be required just to answer a few questions to assess the risk of side effects.”

In their work, the author points to randomized trials in rural Iran, whose findings were published in 2019, showing that polypyrus, photographed for five years, reduced heart attacks and strokes by a third.

In an analysis published last year, the authors compared the best efforts of the NHS health check and the Polypill program (where everyone provided both checks and medication). They found that the Polypill approach would benefit more than twice as much in terms of long-standing life without the resulting heart attack or stroke.

Co-author Nicholas Wald (UCL Institute of Health Infortics) said, “a prevention strategy designed to avoid people becoming patients, not “medical” for most of the population. It can be compared with public health programs such as vaccination, food salt reduction, and acidic acid oxidation.

In the opinion article, the author stated that the next step would be a pilot project to see how national programmes are implemented and to assess intake, compliance and costs.

They write that local governments are legally obligated to provide NHS health checks, so they need an order to grant authorities permission to replace health checks with the Polypill program.

“Current situation is not a valid option,” the author concluded. “We have the means to prevent most heart attacks and strokes. There's more to it than is prevented now. What we need is to translate what we know into actions.”

The opinion article was based on discussions at a consensus building seminar hosted by authors, including prominent health experts in a variety of fields, including cardiologists, neurologists, epidemiologists, pharmacologists, statisticians and policy makers.

Over 7 million people live in the UK with cardiovascular disease. Approximately 100,000 people suffer from heart attacks, and more than 100,000 people suffer strokes each year.