Monday, August 13, 2007
polypil
The study, conducted by a team
led by Dr Shanthi Mendis, WHO’s
Coordinator for Cardiovascular
Diseases, sampled 10 000 patients in
10 low-and-middle-income countries
and found about one-fifth of patients
with coronary heart disease were not
receiving any aspirin and about half
the patients were not on beta-blockers,
which are low cost and widely
available.
Two of the main barriers to
providing adequate care for chronic
conditions are the
limited financial and
infrastructure resources
available for health
care in most lowerincome
countries.
“High-cost, physicianbased
models of care
for chronic diseases
developed mainly
in higher-income
countries are usually
completely unsuited
to lower-income settings,”
said Neal.
The use of fixeddose
combination
therapy in the form
of a single pill for
cardiovascular disease
prevention was first
proposed in a WHO publication on
secondary prevention of noncommunicable
diseases in 2001.
Two years later, Dr Nicholas
Wald and Dr Malcolm Law provided
evidence for the potential efficacy of a
polypill as a public health approach to
cardiovascular prevention in their paper
in the BMJ. The BMJ’s editor at
the time, Richard Smith described the
article as the journal’s most important
for 50 years. They suggested giving a
combination pill containing a statin,
a diuretic, a beta-blocker, an ACE
inhibitor, aspirin and folic acid to all
adults over 55 and to adults of any
age with diabetes or cardiovascular
disease, regardless of risk factors.
This approach contrasts with that
of the Working Group study, which
recommended such treatment for
patients who are at risk of and those
who have had a heart attack or stroke.
The Working Group said it may be
necessary to target such a combination
pill at patients who are at greatest
risk of having a heart attack or stroke
for maximum cost-effectiveness.
This approach could mean targeting
urban areas rather than rural ones.
In urban Delhi, India, 22% of people
older than 55 years of age have more
than a 20% risk of developing cardiovascular
disease over 10 years, whereas
in the rural state of Haryana only 8%
have more than a 20% risk.
WHO has also explored the
benefits of fixed-dose combination
drugs for high-risk patients. Last year,
a WHO report, Priority
Medicines for Europe
and the World: A Public
Health Approach to
Innovation, provided
compelling evidence
that high-risk patients
would enjoy clear
benefits from such
fixed-dose combinations.
Neal said: “The
chief advantages of the
polypill will be that it
will be much cheaper
to manufacture and
distribute and much
simpler to prescribe.”
Because the
components of a
polypill are no longer
covered by patent restrictions it could
be produced at a cost of little more
than US$ 1 per patient per month,
according to the WHO chronic
diseases report. Combination drug
therapy — using aspirin, beta-blocker,
led by Dr Shanthi Mendis, WHO’s
Coordinator for Cardiovascular
Diseases, sampled 10 000 patients in
10 low-and-middle-income countries
and found about one-fifth of patients
with coronary heart disease were not
receiving any aspirin and about half
the patients were not on beta-blockers,
which are low cost and widely
available.
Two of the main barriers to
providing adequate care for chronic
conditions are the
limited financial and
infrastructure resources
available for health
care in most lowerincome
countries.
“High-cost, physicianbased
models of care
for chronic diseases
developed mainly
in higher-income
countries are usually
completely unsuited
to lower-income settings,”
said Neal.
The use of fixeddose
combination
therapy in the form
of a single pill for
cardiovascular disease
prevention was first
proposed in a WHO publication on
secondary prevention of noncommunicable
diseases in 2001.
Two years later, Dr Nicholas
Wald and Dr Malcolm Law provided
evidence for the potential efficacy of a
polypill as a public health approach to
cardiovascular prevention in their paper
in the BMJ. The BMJ’s editor at
the time, Richard Smith described the
article as the journal’s most important
for 50 years. They suggested giving a
combination pill containing a statin,
a diuretic, a beta-blocker, an ACE
inhibitor, aspirin and folic acid to all
adults over 55 and to adults of any
age with diabetes or cardiovascular
disease, regardless of risk factors.
This approach contrasts with that
of the Working Group study, which
recommended such treatment for
patients who are at risk of and those
who have had a heart attack or stroke.
The Working Group said it may be
necessary to target such a combination
pill at patients who are at greatest
risk of having a heart attack or stroke
for maximum cost-effectiveness.
This approach could mean targeting
urban areas rather than rural ones.
In urban Delhi, India, 22% of people
older than 55 years of age have more
than a 20% risk of developing cardiovascular
disease over 10 years, whereas
in the rural state of Haryana only 8%
have more than a 20% risk.
WHO has also explored the
benefits of fixed-dose combination
drugs for high-risk patients. Last year,
a WHO report, Priority
Medicines for Europe
and the World: A Public
Health Approach to
Innovation, provided
compelling evidence
that high-risk patients
would enjoy clear
benefits from such
fixed-dose combinations.
Neal said: “The
chief advantages of the
polypill will be that it
will be much cheaper
to manufacture and
distribute and much
simpler to prescribe.”
Because the
components of a
polypill are no longer
covered by patent restrictions it could
be produced at a cost of little more
than US$ 1 per patient per month,
according to the WHO chronic
diseases report. Combination drug
therapy — using aspirin, beta-blocker,
# posted by roodbont @ 5:31 AM 
