Preventative Medicine Leads to a Reduction of Heart Attacks
Critics of the pharmaceutical industry often find fault in the practice of prescribing medicines to seemingly healthy people in an effort to prevent disease. Said critics abandon the term “disease prevention” in favor of “disease mongering.” They contend that the majority of people on preventative medicines are taking drugs unnecessarily. A person who feels pretty healthy may in fact question why he or she should bother with these pills. Taking a medicine for 10 or 20 years to prevent eventually having a heart attack or getting osteoporosis requires a leap of faith from not just these healthy patients, but from regulatory agencies and physicians as well.
A recent report in the European Heart Journal from researchers at the University College London Medical School provides strong evidence of benefits of taking daily preventative medication. Data from the long-running Whitehall II study of 9,453 civil servants in the UK over 20 years has shown that better control of blood pressure and cholesterol levels and reduction of smoking have led to heart attack rates dropping by 74%. Equally impressive is that this drop has occurred in the face of a rise of the body mass index (BMI) in this population. The researchers believe that a further drop in heart attacks of 11% would be realized if people controlled their weight as well.
The downside to these benefits is that such a preventative regimen requires taking a variety of different pills which helps to drive up costs to patients and health care providers. Furthermore, the combination of drugs could cause problematic adverse drug – drug reactions. Back in 2001, the World Health Organization and The Welcome Trust convened a meeting of experts to discuss evidence-based and affordable interventions for non-communicable diseases. That meeting was the impetus for the creation of the “Polypill” to reduce heart attacks and strokes. The Polypill contains the four key classes of generic drugs used to prevent heart disease: aspirin (75mg), lisinopril (10mg), simvastatin (20mg) and hydrochlorthiazide (12.5mg). Clinical studies are now starting to appear that show the Polypill effectively lowers blood pressure and LDL cholesterol. Remarkably, this multi-component pill is well tolerated with the major side-effect being gastrointenstinal distress due to the aspirin.
The approval of the Polypill will be a big step in the prevention of heart attacks and strokes not just for wealthier nations but also for the developing world. The ease of use and affordability will be a major help for physicians in controlling this disease. Ideally, the continuum of obesity leading to diabetes leading to heart disease will be dealt with by appropriate diet and exercise. Unfortunately, that message is not resonating broadly enough to people around the world. Preventative medicine is here to stay. Managing it properly is the key to controlling health care costs and maintaining a healthy population.