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Doctors urging heart patients to keep taking their tablets would have more success if they used a new combination medicine known as a polypill, according to research published on Tuesday.
An international trial involving 2 000 patients found a four-in-one pill from Dr Reddy's Laboratories Ltd significantly improved adherence, compared with asking people to take their tablets individually.
There were also small but statistically significant improvements in blood pressure and cholesterol levels among those on the polypill, which combines aspirin, a statin to fight cholesterol and two medicines to lower blood pressure.
Dr Simon Thom of Imperial College London, who led the study that looked at 1 000 patients in India and 1 000 in Europe over 15 months, said the polypill offered a low-cost way to improve treatment by making it simpler for patients to stay on therapy.
Poor drug compliance among those at risk of heart disease is a major problem, as people often do not feel any symptoms from their condition and so forget to take their medicine.
Average adherence higher
Average adherence to treatment after 15 months was 86% in patients taking the polypill against only 65% among those on the separate component drugs. The impact was most noticeable among those with a history of poor compliance, where the adherence rate was 77% compared with 23%.
The study results were published in the Journal of the American Medical Association.
The drugs found in the polypill are prescribed separately to millions of patients worldwide and are known to cut the risk of disease, fuelling a debate as to whether they should be routinely combined into a single, cheap treatment.
Heart specialists gathered at the European Society of Cardiology annual meeting in Amsterdam had differing views.
"We know it works well in reducing risk factors," said Dr Koon Teo of Canada's McMaster University, who sees considerable potential in the approach. "Compliance and costs, for some poorer economies, are key benefits."
But other heart doctors said using a fixed-dose polypill would reduce their flexibility to treat patients by adjusting the type and dose of medicines according to their individual needs.
Several different versions of heart polypills are being tested in a variety of clinical trials.
