Dubai, United Arab Emirates (CNN) – Leading cardiologists see the inexpensive “multiple pill” as perhaps one of the best tools for solving heart problems in the world.
This approach to treating heart disease, which experts say could save millions of lives and ward off millions of others from heart problems, is not available in the United States.
Experts pointed out that in places where this treatment is available, it is not sufficiently exploited.
The term “multiple pill” generally refers to a group of drugs commonly used to treat heart disease, including drugs to lower blood pressure, drugs to lower cholesterol (statins), which reduce the strength of the heartbeat, or aspirin.
They are like vitamins for the heart.
Other types of multiple pills are designed to treat other diseases, such as HIV.
In a comment posted Tuesday in the medical journal The Lancet, Fausto Pinto, president of the World Health Federation, and Salem Yusef, executive director of the Population Health Research Institute, wrote that it was time for companies to make more of these pills, and to recommend them from more doctors to their patients.
‘global tragedy’
Heart disease is the leading cause of death worldwide.
About 18 million people die each year from heart problems, and about 54 million people suffer from heart disease.
In the United States alone, about half of adults have some form of cardiovascular disease, and one person dies from it every 34 seconds, according to the U.S. Centers for Disease Control and Control (CDC).
As risk factors such as obesity and diabetes rise, heart problems will continue to rise, particularly in communities already disproportionately affected by health problems, such as the black community, and in families with limited access to health. health care, such as those living in rural areas or poor communities.
For nearly two decades, doctors have debated the multiple pill, concluding that it would be a simple and inexpensive way to prevent heart problems.
But few companies make them, and even when they are available, few people use them, the comment states.
“This systemic failure is a global tragedy, as many premature deaths from cardiovascular disease could be avoided,” Pinto and Youssef wrote.
Both Pinto and Youssef point to a growing body of evidence to suggest that the multiple pill can reduce heart problems, with few side effects.
Studies also show that when people can only take one pill, rather than multiple pills, they tend to choose the former option.
Another advantage is that the multipill can be made with generic ingredients, so it can be inexpensive.
The comment said that during recent independent long-term studies, there was “clear and resounding” evidence that this pill actually works for primary prevention, meaning a person can take it even if they haven’t had a heart attack or stroke. , and as a secondary prevention, after a cardiomyopathy attack;
Data from these three studies also showed that the multiple pill reduced the risk of heart disease by nearly 40%.
There was also a 50% relative risk reduction when scientists included aspirin in the pill formula.
Positive results have been seen in people with a wide range of underlying risk factors, such as hypertension and high cholesterol.
Pinto and Youssef estimate that even if half of people at risk for heart disease took the multiple pill, it could prevent about 2 million deaths from heart disease a year and protect 4 million people from heart disease.
They wrote: “The evidence of the multiple pill’s benefits is now substantial. It is time for the multiple pill to be widely used to save millions of lives every year.”
It is worth noting that the multipill is not on the World Health Organization’s list of drugs that are considered the most effective and safe to meet the most important needs of the health system.
Such an addition would prompt governments and insurance companies to encourage doctors to recommend it, according to Pinto and Youssef.
Controversy on the category entitled to the multipill
Donald Jones, former president of the American Heart Association and a cardiologist at Northwestern University School of Medicine, points out that there is a large body of evidence that the multi-pill can be safe and can reduce heart attacks and strokes.
Eating a healthy diet and exercising can keep the heart healthy, but some people may not have access to healthy food or may live in neighborhoods where it is not safe to walk out.
For Dr. Dariush Mozaffarian, cardiologist, Dean of Policy and Professor of Nutrition at Tufts University’s Friedman School of Nutritional Science and Policy, he is against the idea of making the multipill available at the population level, even in vulnerable communities.
Mozaffarian claimed to have initiated some discussions with other scholars on the subject.
For most people, there should be a multiple approach to health rather than a multiple pill.
“Making access to healthy foods more accessible and making a healthy lifestyle more achievable,” Mozaffarian explained.
“These are the treatments we should invest in for primary prevention,” he added.
However, Mozaffarian advocates the use of the multipill as a secondary prevention, after a heart attack, or in other high-risk people.
Seeking permission to use
Valentin Foster, director of the Mount Sinai Heart Center and director general of the National Center for Cardiovascular Examination in Madrid, Spain, published the results of a large multiple-pill study in the New England Journal of Medicine last month.
Foster said he agrees that more companies should make them, but it’s not easy.
Foster’s team tried 50 different types before creating a drug combination that seemed to work best.
The multiple pill his team designed is a combination of an ACE inhibitor to lower blood pressure, a statin to lower cholesterol, and aspirin.
Results from the last phase of his study showed that people who had a heart attack and took the pill had a 33% lower risk of dying from cardiovascular disease and also helped reduce other problems, such as strokes and subsequent attacks. of heart.
The results have been very positive, Foster said, and he will submit them to the Food and Drug Administration for approval of his team’s multiple pill.
Foster believes this pill should only be given to people who have had a heart attack, rather than as a preventative drug.
