How to Get Heart Patients to Take Their Pills? Give Them Just One.

Despite advances in treatment and prevention, many patients don't stick to their medication A polypill is a combination of drugs needed to prevent cardiovascular problems.

In the largest and longest randomized controlled trial of this approach, patients who were prescribed a poly pill within six months of a heart attack were more likely to keep taking their drugs.

The participants' risk of death from all causes was not changed.

The study of more than two thousand heart patients who were followed for three years was published in The New England Journal of Medicine.

The study is the culmination of 15 years of work by researchers led by Dr. Valentin Fuster, director of Mount Sinai Heart at Mount Sinai Hospital in New York City.

Dr. Thomas J Wang, chair of the department of internal medicine at UT Southwestern Medical Center, was not involved in the research but wrote an editorial about the benefits of combination pills.

One pill is easier to take than multiple pills, and it is also easier to take them once a day.

The availability of a poly pill seems to make physicians write more prescriptions in line with practice guidelines.

A cholesterol-lowering drug and aspirin are included in the polypill. The idea of giving a daily poly pill to everyone when they turn 55 was first floated two decades ago.

That idea was quickly dismissed. The benefits of a poly pill for patients at risk of heart problems have been tested many times. Polypills can be used to treat H.I.V. and other diseases.

The Food and Drug Administration has not approved the use of the poly pill in the United States. The results of the new trial will be submitted to the agency soon.

He said the benefit of the polypill for prevention was comparable to low-dose aspirin, which is now routinely prescribed to people who have already had a heart attack.

With more follow-up, the potential results could be even better. According to several studies, only a small percentage of patients take their medication as directed.

A randomized controlled clinical trial was conducted in Spain, Italy, France, Germany, Poland, the Czech Republic and Hungary.

All of them had survived a heart attack. They were either over the age of 75 or over the age of 65 with at least one health condition. Over half had a history of smoking, and 80 percent had high blood pressure.

The majority of the patients were white. Most of the people were not high school graduates.

The polypill was given to half of the trial participants. Treatment was tailored to each patient.

Doctors were able to choose between three and two doses of ramipril, a blood pressure drug, and between two and 100 milligrams of aspirin, all of which were contained in the poly pills.

Adherence to medication was higher for poly pill users. At six months, 70.6 percent of the polypill group were sticking to their regimen, compared with 60.7 percent of the usual assortment of pills.

At 24 months, about three-quarters of the patients were still taking a poly pill, compared with the majority of patients taking the usual pills.

Patients who took an assortment of pills had a higher risk of having a heart attack, stroke, or dying of a cardiac event, compared with patients who took a poly pill.

The reduction in cardiovascular deaths in the poly pill group was offset by deaths from other causes.

Dr. Fuster said, "People forget when there are a number of pills to be taken, they don't take all of them or they take nothing."

Adherence drops off after the first few months after a heart attack, according to him.

The polypill might be cheaper to produce and distribute than a series of pills. It is possible that the findings will help make cardiovascular prevention therapy more accessible.

The European study had a very homogeneity of patients, but other studies have looked at the use of polypills in minority and underserved populations.

A low-income, mostly black group of adults in Alabama were prescribed a poly pill to prevent cardiovascular disease. Adherence was very high and the participants saw a decrease in cholesterol and blood pressure.

Significant reductions in cardiovascular risk factors were found in a review of eight studies.

There was a decline in overall mortality among patients assigned to take poly pills, as well as serious cardiac events among those who had no previous heart disease.