Heart disease remains the world’s leading cause of death, but many of its biggest risks can be treated with medicines that have been available for years.
Researchers from Tehran University of Medical Sciences and their colleagues tested whether putting several of these medicines into a single low-cost pill could make prevention easier.
The approach is known as a polypill. Instead of asking people to remember several separate medicines each day, the polypill combines commonly used heart drugs in one tablet, making treatment simpler and potentially more affordable.
The research was reported in The Lancet as part of the large PolyIran study. The trial took place in Iran and included about 6,800 adults between 50 and 75 years old, including people with and without a previous history of heart disease.
Everyone taking part received advice about healthy habits, such as eating well, staying physically active, avoiding smoking, and controlling major heart risks. About half of the participants were also offered a daily polypill, while the other half received the lifestyle advice without the pill.
The polypill contained four familiar medicines. It included low-dose aspirin to reduce blood clotting, atorvastatin to lower cholesterol, and two blood-pressure medicines, hydrochlorothiazide and enalapril.
These medicines are not new, and doctors have long used them to lower the risk of heart attacks and strokes. The important idea was to put them together so that people at higher risk could follow a simpler daily treatment plan.
After about five years, the difference between the groups was clear. Roughly 6% of people in the polypill group experienced a major heart-related event, compared with about 9% of those who received lifestyle advice alone.
This translated into about a one-third lower risk in the main analysis. When the researchers took other heart medicines used by participants into account, the protective effect became smaller but was still meaningful.
People who regularly took the polypill appeared to receive greater protection than those who did not take it consistently. This supports a basic problem in long-term medical care: even an effective medicine cannot work well if people frequently forget or choose not to take it.
Taking many separate tablets can be difficult, especially for older adults or people managing several health problems. A single combined pill may remove some of that daily burden and make it easier for patients to stay with their treatment.
The study also suggested that lowering cholesterol was an important part of the benefit. High levels of harmful cholesterol can slowly contribute to fatty deposits inside arteries, which can narrow blood vessels and increase the chance of a heart attack or stroke.
The findings may be particularly useful in countries where regular medical appointments, laboratory tests, and multiple prescription medicines are difficult to afford or obtain. A cheap, simple pill made from widely available drugs could offer a practical way to protect many people at increased cardiovascular risk.
However, a polypill is not suitable for everyone. Aspirin and blood-pressure medicines can cause side effects, and the best combination depends on a person’s health, other medicines, and individual risks, so treatment should still be discussed with a healthcare professional.
Overall, the PolyIran study showed how an old set of medicines could become more useful when delivered in a simpler form. Rather than depending on a new and expensive drug, the strategy could make proven heart protection easier to use and potentially help prevent many heart attacks and strokes worldwide.
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