Cardiovascular superpill on the horizon

  • The superpill brings together four preventive medications usually prescribed separately
  • It will lower cholesterol and hypertension

All patients, following a first cardiovascular incident, must take medicine to prevent any chance of relapse. Medications that lower hypertension along with blood thinners can decrease fatalities or the impact of motor or cerebral disabilities stemming from cardiovascular incidents.

Following a study published in the latest issue of Jama, however, the percentage of patients who take their treatment effectively is very low: one of every two patients with cardiovascular disease and one of every three that have already suffered a stroke. The issue is mostly due to the complexity of taking several medications at different doses at different times. Since these drugs lower risk but are not necessarily physically perceived, many patients forget their benefits.

An innovative strategy that would improve the effect of these preventive drugs has arrived in the form of a “superpill”. It combines several medications into one to simplify the patient’s life. What is the actual effect on the patient? A new study has just demonstrated exactly that. Researchers combined a platelet aggregation inhibiting drug, a statin (anti-cholesterol) and two drugs that lower arterial hypertension. The patients had suffered a first cardiac incident or displayed a 15% chance of such an incident within the next five years. This percentage is calculated according to the patient’s blood tests through their cholesterol levels as well as tobacco use or diabetes.

Blood pressure lowered

Patients received a superpill combining 75 mg of aspirin, 40 mg of simvastatin, 10 mg of lisinopril and 50 mg of atenolol for a period of two years. The other patients received the equivalent of these medications separately, as they’re normally prescribed. Conclusion: While 929 out of the 961 patients who had received the superpill kept following their treatment, only 621 of those who took the medicine separately stayed with their treatment. This showed a 22% improvement in treatment compliance. This difference had an effect on systolic pressure – it lowered by 2.6 mm, while the LDL (bad cholesterol) dropped by 4.2 mg/dl. “There were modest but significant reductions,” say the authors. This reduction was greater among patients who were not as good at taking their treatment.

Does this mean that all similar treatments should be turned into these more effective “superpills”? “It’s obvious that this helps in treatment compliance,” admits professor Guy Berkenboom, director of the Erasmus Hospital (ULB) cardiology department. “But the superpill’s advantage is also its drawback. Many different medications exist that have similar results. Most are more recent than those used in this study. In addition, the correct doses can vary greatly between individuals. The superpill only comes in fixed doses that can’t be changed. Another issue is, if a patient is temporarily short of one of his four preventative drugs, the risk due to treatment delay is not very high. On the other hand, if he’s short of a superpill, the risks increase significantly.” The specialist does not, however, necessarily dismiss this solution. “There are already combinations of two drugs such as a hypertension medication, lisinopril, along with a diuretic or a beta blocker. It’s more flexible than a combination of four different drugs”.

FRÉDÉRIC SOUMOIS

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