Monday, 29 October 2012


Student BMJ- The polypill: a magic bullet against cardiovascular disease?(

The polypill is "a pill containing a number of medicines that all treat the same condition" (Oxford Dictionary) from 'poly', meaning many.
"Cardiovascular disease remains the leading cause of mortality in developed countries, and has been described as a “global epidemic.” In 2003, Wald and Law proposed a new polypill: six drugs combined into one tablet that would work to reduce cardiovascular risk. They proposed the polypill as a way of targeting modifiable cardiovascular risk factors, both for adults with pre-existing cardiovascular disease (secondary prevention) and, more controversially, for adults over 55 years old without cardiovascular disease (primary prevention)."

"Wald and Law argued that over 80% of myocardial infarctions and strokes could be prevented if this strategy was adopted. The polypill would contain six ingredients: three blood pressure lowering drugs (a thiazide diuretic, a β blocker, and an angiotension converting enzyme (ACE) inhibitor), a statin, aspirin, and folic acid. Their idea ignited great debate in the medical community regarding its potential to reduce the global burden of cardiovascular disease" (BMJ reference above).

How well does the pill work?
"By using the right combination of active medicines, the Polypill can reduce the risk of a heart attack or stroke by two thirds. The key objectives of the medicines are to reduce blood pressure and cholesterol."

"In July 2012, the results of a Polypill trial conducted at the Wolfson Institute of Preventive Medicine, were published. The trial was conducted among individuals aged 50 and over without a history of cardiovascular disease and without selection on the basis of blood pressure or cholesterol. The reductions in blood pressure and cholesterol were recorded and compared with those predicted from published estimates of the effects of the individual components.
84 participants took a single Polypill (containing amlodipine, losartan, hydrochlorothiazide and simvastatin) each evening for 12 weeks and a placebo each evening for 12 weeks in random sequence (a randomised cross-over trial).

In this trial, participants and doctors did not know whether the Polypill or the placebo was taken during each period (double-blind). The reduction in blood pressure and cholesterol at the end of the Polypill period was compared with the levels at the end of the placebo period. The allocation of the placebo or the Polypill is coded, and is only revealed at the end of the study. This study design provides more precise and accurate estimates of the blood pressure and cholesterol lowering effects of the Polypill than other kinds of study. Systolic blood pressure was reduced by an average of 17.9 mmHg (12%) on the Polypill, diastolic blood pressure by 9.8 mmHg (11%), and LDL cholesterol by 1.4 mmol/L (39%). The results were almost identical to those predicted; 18.4 mmHg, 9.7 mmHg, and 1.4 mmol/L respectively" (

The two graphs below ( show the effect that the polypill has on diastolic blood pressure and cholesterol respectively both lowering to almost the levl of a 20 year old.

Whilst showing a reduction in diastolic blood pressure and LDL (low density lipoproteins) cholesterol in the graphs, this considerably lowers the risk of coronary heart disease and also the risks of stroke ( and
"If people took the polypill from age 50, an estimated 28% would benefit by avoiding or delaying a heart attack or stroke during their lifetime" (

However "The British Heart Foundation called for more research and said pills were not a substitute for a living a healthy life." ( This study was also a very small study of just "84" (BBC) over 50 year olds, a much larger study would have to be carried out to provide solid data and evidence to become valid and broadly used.


Saturday, 13 October 2012

Medical Mash Up

BBC- NHS and US health system 'should share ideas' (

Before reading the article you would think that it was a good suggestion to share ideas and learn from different mistakes made. However to compare the two nations proves difficult in the size of the population and also their distribution between built up and rural areas.

The Telegraph Online website shows the population densities of the UK: and the USA: with the USA clearly showing that it has large areas of very low population density compard to the UK which has a very high population density across the whole country.

Specifics that one could learn for the other include "NHS, which is in the middle of a £20bn savings drive in England, could learn from the transparency and analytical rigour provided by bodies such as the Congressional Budget Office in the US. And lessons learned from the NHS's rollout of universal electronic health care records could prove helpful to the US, which is much further behind on the issue."

"But both countries are under pressure to get more value out of health care spending and reduce growth in expenditure to sustainable levels and are consequently experimenting with new ways to encourage clinicians, patients and institutions to help achieve this." But maybe not copying another system is the way to do this, maybe ingenuity is needed?

BBC-Kaylee Davidson-Olley marks 25 years with new heart (

"She said: 'I cannot believe that I am fit and healthy 25 years after my transplant. This was only made possible because of the generosity of a family who made that important decision about organ donation, a decision that saved my life. Without that family discussing organ donation, I simply would not be here.'"

"In total, 112 babies aged under a year have received new hearts in the UK during the past 25 years." of the most inpirational stories I have seen in a while!!