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Perspectives: Combination Pharmacotherapy and Public Health Research Working Group* Combination Pharmacotherapy for Cardiovascular Disease Ann Intern Med 2005; 143: 593-599 [Abstract] [Full text] [PDF]

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Problems With the Polypill

Mark R Goldstein   (15 November 2005)

Problems With the Polypill 15 November 2005
Mark R Goldstein, MD Send rapid response to journal: Re: Problems With the Polypill markrgoldstein{at}comcast.net Mark R Goldstein	The widespread use of a "polypill" (a combination of a statin, a diuretic, a beta-blocker, an angiotensin-converting enzyme inhibitor, aspirin and folic acid)proposed for the prevention of cardiovascular disease will be problematic (1). It will de-emphasize prevention by lifestyle change, homogenize treatment for heterogeneous populations and violate the "first do no harm" dictum. The assumption is that a majority of people will benefit from a given combination of medications despite their individual problems. That assumption is dangerous. What about individuals who require surgery and must stop aspirin one week prior to the proceedure? Abruptly stopping a beta-blocker may lead to myocardial ischemia. What about individuals with renal insufficiency who use a salt substitute containing potassium chloride and become hyperkalemic because of the angiotensin-converting enzyme inhibitor? Presently, there is controversy as to whether folic acid supplementation may increase cancer(2). The best measures for cardiovascular disease prevention are a diet rich in fruits, vegetables, whole grains and low-fat dairy, and regular exercise, started in childhood and maintained throughout life(3). Perhaps, the Public Health Research Working Group could have better utilized the approximately 700,000 pages of the Annals (100,000 issues in circulation,7 page article) by discussing ways to better implement lifestyle change in our population of rapidly expanding waistlines(4). References 1) Combination Pharmacotherapy and Public Research Working Group. Combination pharmacotherapy for cardiovascular disease. Ann Intern Med. 2005; 143: 593-599. 2) Bonaa KH (for the NORVIT Study Group). NORVIT: Randomised trial of homocysteine-lowering with B vitamins for secondary prevention of cardiovascular disease after acute myocardial infarction. European Society of Cardiology, September 3-7, 2005, Abstract 1334. 3)McGill HC, McMahan CA. Starting earlier to prevent heart disease. JAMA. 2003; 290: 2320-2322. 4)Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the Third National Health and Nutrition Examination Survey. JAMA. 2002; 287: 356-359. Conflict of Interest: None declared