A "polypill" containing a fixed-dose of aspirin, a statin and one or two blood-pressure-lowering drugs, has enormous potential in developing countries, where the rate of cardiovascular disease is rising rapidly, according to an expert working party.
No fixed-dose combination pill of this kind has been widely marketed anywhere in the world to date, and the full benefits of such a pill remain unclear until it can be put to the test in upcoming large-scale clinical trials in India and New Zealand.
"Combination pharmacotherapy offers the potential to decrease the incidence of cardiovascular disease worldwide, perhaps especially in people who have never had a cardiovascular event," concluded the Combination Pharmacotherapy and Public Health Research Working Group, convened by the Centers for Disease Control and Prevention in the United States.
The report, which was published in the Annals of Internal Medicine in October 2005 (Vol. 143, pp. 593-599), came up with the dramatic finding that combining several anti-hypertensive drugs at low doses is likely to be more effective and have fewer side-effects than high-dose therapy with a single drug.
However, more research is needed on the side-effects and bioavailability as well as tolerability and adherence to combination pills. "Combination pharmacotherapy may prove especially effective in the developing world, where studies may precede those done in wealthier countries," the report concluded.
The study's findings provide a timely boost to efforts to improve access to treatment for chronic diseases in developing countries. Chronic diseases are often associated with developed countries, but their prevalence is increasing in many low-and-middle-income countries, according to the recent WHO report, Preventing chronic diseases: a viral investment. Only 20% of chronic disease deaths occur in high-income countries--while 80% occur in low-and-middle-income countries and these deaths occur in equal numbers among men and women, the report said.
Deaths from infectious diseases, maternal and perinatal conditions, and nutritional deficiencies combined are projected to decline by 30/0 over the next 10 years globally: However, over the same period deaths due to chronic diseases are projected to increase by 17%.
A recent study carried out in Andhra Pradesh found that noncommunicable and chronic diseases are the leading causes of death in this rural state of India. One of the authors of the study, Dr Bruce Neal, Director of the Cardiac and Renal Division at the George Institute for International Health, in Sydney, said that the health delivery system was in urgent need of "reorientation" to enable the implementation of evidence-based strategies to address the challenge of noncommunicable diseases.
Neal told the Bulletin: "While many lower-income countries have made very substantial advances in the treatment and prevention of acute communicable conditions and in the management of maternal and child health, services for chronic disease care are relatively undeveloped."
Dr Robert Beaglehole, Director of WHO'S Department of Chronic Diseases and Health Promotion, said: "The epidemic of chronic disease is rapidly evolving, the threat is growing, but the response is not keeping pace. More and more people are dying too early and suffering too long from chronic diseases. We know what to do to prevent most of this and so we must act now."
"There are important gaps that could readily be filled if health systems use measures that are already available relatively cheaply, such as aspirin," said Beaglehole. This was illustrated by the WHO-PREMISE study published in the Bulletin last month.
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. …