Recently I have had a few patients who have started the polypill, which has prompted me to wonder what has happened to this preventative treatment for cardiovascular disease?

Six years ago it was claimed in the British Medical Journal that this single daily concept containing six constituent medications had the potential to reduce rates of heart attack and stroke in those aged 55 or over by more than 80 perc cent and an accompanying editorial described this as one of the boldest claims for a new intervention.

At the time this article prompted a wide range of comment from outraged condemnation of the supporting assumptions to broad support and optimism, but in the meantime the program has not generated widespread uptake and there have been no large trials set up to confirm or refute these dramatic claims and consequently no polypill formulation has been licensed in Europe or USA.

Aspirin was originally included in the formulation but has now been dropped whilst there are a number of large trials investigating the potential benefit of aspirin in such patients.

The polypill concept includes four drugs which are currently licensed and used conventionally to treat high blood pressure or high cholesterol, particularly in patients considered to be at risk of having a cardiovascular event, either when these clinical measurements are considered to be abnormally high in unaffected patients- primary prevention-, or in patients who have already had a cardiovascular event- secondary prevention.

Much of the work of a General Practitioner and his or her team is already spent identifying these patients and treating them according to evidence based guidelines, so why has this apparent panacea not really caught on?

Firstly the evidence quoted in the original BMJ article assumed an additive preventative effect of these medications, which many commentators have disagreed with.

Also it did not consider the possible negative effects of such medication and three of the components drugs, Lisinopril, bendrofluazide and Simvastatin, are usually monitored for potential serious side effects by prescribing doctors. On a less serious scale, Lisinopril can cause a troublesome cough in up to ten per cent of patients. Bendrofluazide can cause gout and body salt imbalance as well as having some adverse effect on cholesterol and simvastatin can cause intestinal upset and muscle pain or weakness.

Amlodipine is used, usually in higher doses, by doctors to reduce blood pressure.

However beyond this potential beneficial effect, I am not aware of other more specific outcome benefits for this drug in asymptomatic patients.

It is also a drug that has a high discontinuation rate due to inconvenient side effects such as ankle swelling.

The dose of all of these drugs is usually titrated against their clinical effect and although patients are usually screened for their suitability, it does not appear that blood pressure or blood biochemistry are measured routinely in patients on the polypill program and the treatment is not subsequently tailored to the individual.

Some large companies offer this screening process as part of their well person screening and then individuals are then required to pay £15 per month for the medication, which is not otherwise available on the NHS.

So although this is an interesting idea, it currently appears to be no more than an optimistic ‘shot in the dark’ at reducing heart disease when there are far more effective preventative measures such as smoking cessation, healthy diet, weight reduction and exercise and specific targeted treatment of at risk individuals.

These however involve much more personal effort than taking a single pill.

Meanwhile there will of course be individuals who want to do all they can to reduce heart disease, but I am not sure that Cancer or Alzheimers are necessarily more attractive options.