Dubai, United Arab Emirates (CNN) — Leading cardiologists see the inexpensive “multi-pill” as perhaps one of the best tools for solving heart problems around the world.
This approach to treating heart disease, which experts say could save millions of lives, and avert millions more 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 medications commonly used to treat heart disease, including blood pressure-lowering drugs, cholesterol-lowering drugs (statins), which reduce the force of the heartbeat, or aspirin.
They are like vitamins for the heart.
Other types of the multi-pill are designed to treat other diseases, such as HIV.
In a commentary published 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 produce more of these pills, and to recommend them by more doctors to their patients.
‘global tragedy’
Heart disease is the number one cause of death around the world.
About 18 million people die of heart problems each year, 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 US Centers for Disease Control and Control (CDC).
As risk factors such as obesity and diabetes increase, heart problems will continue to grow, particularly in communities already disproportionately affected by health issues, such as the black community, and families with limited access to health care, such as those who live in rural areas or in poor communities.
For nearly two decades, doctors have debated the multi-pill, concluding that it would be an inexpensive and easy way to prevent heart problems.
But few companies manufacture them, and even when they are available, few people use them, the commentary said.
“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 suggesting that the multi-pill can reduce heart problems, with few side effects.
Studies also show that when people are allowed to take just one pill, rather than several pills, they tend to go for the first option.
Another advantage is that the multi-pill may be made with generic ingredients, so it can be inexpensive.
The commentary said that during recent independent long-term trials, there was “clear and resounding” evidence that this pill really works for primary prevention, which means a person can take it even if they haven’t had a heart attack or stroke, and as secondary prevention, after an attack. cardiomyopathy;
Data from these three trials also showed that the multi-pill reduced the risk of heart disease by nearly 40%.
There was also a 50% relative risk reduction when the scientists included aspirin in the pill formula.
Positive results were seen in people with a wide range of underlying risk factors, such as high blood pressure and high cholesterol.
Pinto and Youssef estimate that even if half of people at risk of heart disease took the multi-pill, it could prevent about 2 million heart disease deaths annually, and protect 4 million people from heart disease.
They wrote: “Evidence for the benefits of the multi-pill is now substantial. It is time for the multi-pill to be widely used to save millions of lives annually.”
It is worth noting that the multi-pill is not on the World Health Organization’s list of medicines that are considered the most effective and safe to meet the most important needs in the health system.
Such an addition would prompt governments and insurance companies to encourage doctors to recommend it, according to Pinto and Youssef.
Controversy over the category entitled to receive the multi-pill
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 may be safe and can reduce heart attacks and strokes.
Eating a healthy diet and exercising may keep the heart healthy, but some people may not have access to healthy food, or they may live in neighborhoods where it’s not safe to walk outside.
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 multi-pill available at the population level, even in vulnerable communities.
Mozaffarian said he has entered into some discussions with other scholars on the subject.
For most people, there should be a multiple approach to health rather than a multiple pill.
“Make access to healthy food more accessible, and make a healthy lifestyle more achievable,” Mozaffarian explained.
“These are the treatments we should invest in for primary prevention,” he added.
However, Mozaffarian supports the use of the multi-pill as a secondary prevention, after a heart attack, or in other people at high risk.
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 trial of the multi-pill in the New England Journal of Medicine, last month.
Foster said he agrees that more companies should make them, but that’s not easy.
Foster’s team tried 50 different types before creating a combination of drugs that seemed to work best.
The multi-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 trial showed that people who had a heart attack and took the pill had a 33% lower risk of dying from cardiovascular disease, and it also helped reduce other problems, such as stroke and subsequent heart attacks.
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 multi-pill.
Foster believes this pill should only be given to people who have had a heart attack, rather than as a preventative drug.