http://www.nytimes.com/2003/06/26/health/26CND-PILL.html?ex=1057723200&en=ab06abb3fa5efa34&ei=5070

British Scientists Suggest a Pill for What Ails the Heart

By MARY DUENWALD

wo British scientists have proposed a radical strategy for preventing cardiovascular disease: a daily pill that would be prescribed to everyone over the age of 55, regardless of their risk of heart attack or stroke.

The yet-to-be-created "polypill," as the scientists call it in a paper published today in the British Medical Journal, would contain six different drugs: a cholesterol-lowering statin; three kinds of blood pressure medications; folic acid, to reduce homocysteine, which is thought to be a risk factor for heart disease, and aspirin, which can help prevent the buildup of plaque in the arteries.

If people took the pill daily, they would lower their risk of heart attack by 88 percent and of stroke by 80 percent, the scientists claim. They calculate that one-third of those taking the drug would gain an average of 11 years of life, free of cardiovascular disease.

"It's important to implement the treatment on a wide scale," said Professor Nicholas Wald, a co-author of the article and an epidemiologist at the University of London. "I believe that tailoring treatments for cardiovascular disease is creating a lot of needless testing."

In an accompanying editorial, Dr. Anthony Rodgers, of the University of Auckland, New Zealand, called the strategy "bold" and deserving of consideration and debate. Before such a pill could be created, he noted, doctors would have to figure out whether six drugs combined into one pill would have unexpected side effects.

If any such drug were to be created, Dr. Rodgers argued, it would be important to ensure that it became available not only in developed countries like Britain and the United States but also in the developing world. "Compared with developed countries many times more lives could be saved," he wrote.

But Dr. Robert O. Bonow, president of the American Heart Association, called the benefits of the polypill "purely speculative."

"It's dangerous and speculative to tell the American people that they can take a pill to prevent cardiovascular disease," he said, "and then go on smoking, and not exercising, and being overweight."

He questioned the British scientists' recommendation that the pill be prescribed without even measuring each person's cardiovascular risk factors. Some people might be undertreated for high cholesterol and blood pressure.

Others, meanwhile would be overtreated, Dr. Bonow said, setting themselves up for unnecessary side effects. Bleeding complications from daily aspirin would be a particularly worrisome risk, he said.

Anywhere from 8 to 15 percent of those who took the drug could be expected to suffer side effects from the individual ingredients, the British scientists calculate. People with a particular sensitivity to aspirin should be excluded from the mass prescription, they said.