Nicholas Wald

There is no denying that a combination pill for cardiovascular care, something that Wald calls the "Polypill," could find a large patient base. (There is a trademark application for the name Polypill.) Heart disease and stroke are responsible for about one-third of all deaths in Western nations, said Wald, director of the Wolfson Institute of Preventive Medicine in London.

Heart attacks and strokes can be prevented by reducing LDL cholesterol, lowering blood pressure, and reducing platelet aggregation. Wald would add to the list reducing blood levels of the amino acid homocysteine.

While lifestyle changes are the first defense, they are not always followed or successful. Enter pharmaceutical therapies, which include statins to lower cholesterol, medicines to reduce blood pressure, folic acid to lower levels of homocysteine, and aspirin to reduce platelet aggregation.

Wald’s concept is that these drugs and vitamins be combined into a yet-to-be-developed Polypill targeted for daily preventive use by people over the age of 55, even if they do not have diagnosed heart disease, since their age alone puts them at higher risk for cardiovascular disease.

Wald and co-author Malcolm Law described the Polypill in the British Medical Journal last year. In the paper, they offer a formulation based on analyzing published meta-analyses of randomized trials and cohort studies of the Polypill’s proposed components. Dosage would be keyed to benefit the average person, but Wald said dosages could theoretically be adjusted.

The proposal has the potential to prevent more than 80 percent of heart attacks and strokes, said Wald. "One in three people over the age of 55 could gain from taking the Polypill," he said. Some people could add as many as 21 years to their lives without a heart attack or stroke, he said.

A question-and-answer period followed. One person asked if such a pill could be affordable. Wald noted that the cost of producing the Polypill would likely be more expensive than the individual costs of its components. Yet, he predicted the pill would not need to be very expensive, if its production and distribution followed usual trends.

Getting the pharmaceutical industry on board is a separate challenge. Wald predicted that one of the pill’s biggest impediments would be countering resistance to its development by companies that stand to lose money if their individual heart medications become less useful because of a combination pill.

An audience member asked why Wald would expect people to take the Polypill regularly if they failed to change their lifestyles to protect against heart disease. Wald responded that many adults already take some of the components of the Polypill and that many Americans are used to taking pills regularly.

Wald was introduced by Meir Stampfer, chair of the Department of Epidemiology. The Cutter Lectures are organized by the Department of Epidemiology under the terms of a bequest from John Clarence Cutter, MD, a graduate of the Harvard Medical School.

A web cast of the lecture is available at www.hsph.harvard.edu/live/Cutter-Nicholas-Wald.html.

--PHC