MIAMI--(EON: Enhanced Online News)--While scientists work to develop a single pill that will reduce the overall risk of heart attacks and heart disease, research conducted by a Baptist Health South Florida physician, leading a team of experts from multiple centers, indicates only people with calcium in their arteries may benefit from the so-called “polypill.” That research is being published today in the Journal of the American College of Cardiology (JACC).
“Although the concept of combining well-proven medications in a single pill for ease of use is an attractive option, it comes with the risk of over treating a lot of individuals who may not benefit or need them”
A “polypill” in development combines three or more medications people now take to prevent heart disease and stroke into one pill. Some medical experts believe giving this treatment to all people over age 50 or to those with specific risk factors for heart disease –– the number-one killer worldwide –– would significantly reduce the overall number of heart attacks and cardiovascular deaths in this population over the long run.
Other medical experts are concerned that giving the polypill to an entire population will expose a lot of people who are unlikely to develop heart disease to potential side effects and also unnecessarily increase the overall costs of prevention.
Analysis by lead author Marcio Sommer Bittencourt, M.D., and senior investigator, Khurram Nasir, M.D., MPH, director of wellness and prevention research at Baptist Health Medical Group in South Florida, found a simple scan that reveals the amount of calcium in a person’s coronary arteries can identify people most and least likely to benefit from polypill treatment ahead of time.
“Although the concept of combining well-proven medications in a single pill for ease of use is an attractive option, it comes with the risk of over treating a lot of individuals who may not benefit or need them,” Dr. Nasir says.
The scan gives doctors a simple number –– a Coronary Artery Calcium (CAC) score –– that places people in low, moderate or high-risk groups before they develop any symptoms. The CAC score corresponds to whether someone is likely to develop heart disease or not. The study’s results were determined after Drs. Nasir and Bittencourt and their associates looked at thousands of patients in the Multiethnic Study of Atherosclerosis (MESA) study, which follows the same criteria used in four studies of the polypill.
People with a CAC score greater than 100 were most likely to experience an adverse cardiovascular event –– including a heart attack or cardiovascular-related death –– during a mean of more than 7.5 years of follow-up. People with a score between one and 100 had moderate risk. Those with a CAC of zero (no evidence of early atherosclerotic disease) theoretically could safely defer polypill treatment, the researchers found.
“The most important finding of our study is that it shows the majority of individuals who may meet criteria for these medications have no atherosclerosis or plaque buildup in the arteries of the heart, have a less than one in 1,000 chance per year of having a heart attack, and may not benefit from the polypill,” Dr. Nasir says. “In contrast, targeting this potentially effective prevention treatment to the 15-20 percent of people who experience the majority of heart attacks makes more sense,” Dr. Nasir says.
The strategy also could be cost-effective, according to Dr. Nasir. Each scan costs approximately $75 to $100, and the study suggests only 20 high-risk individuals with moderate calcium scores would need to be treated over five years to prevent one adverse cardiovascular event.
In an accompanying editorial in JACC, William Wijns, M.D., Ph.D., and Dan Rusinaru, M.D., Ph.D., of the Cardiovascular Research Centre Aalst, Belgium, commented: “The results of this analysis are of great interest.” The writers describe use of the CAC score to guide treatment as an ‘innovative approach’ but raise some concerns, including the limited availability of the scanning technology in emerging countries and the amount of radiation exposure from the scan, which they describe as low but still greater than a chest X-ray.
Dr. Nasir and his colleagues describe the amount of radiation as low and equivalent to radiation delivered by a mammogram to both breasts.
Because coronary artery disease can develop over time, further research is needed to show how often patients with lower risk need to return for reevaluation, Dr. Nasir says. The specific medications –– such as aspirin, a statin and a blood pressuring lowering agent –– that might be included in a polypill approved in the United States have yet to be determined, and the long-term prevention benefits remain unknown.
Dr. Nasir has more than 250 peer-reviewed articles to his credit published in top journals, including Lancet, New England Journal of Medicine, JAMA, Archives of Internal Medicine, Circulation, Journal of American College of Cardiology and European Heart Journal. He also is associate editor of two leading journals, Atherosclerosis and Circulation: Cardiovascular Quality and Outcomes, serves as chair of the Prevention Council of the Society of Atherosclerosis Imaging and Prevention, and is a member of the American Heart Association’s Statistics Committee of the Epidemiology & Prevention Council. Dr. Nasir has lectured extensively throughout the world on coronary arthrosclerosis, cardiac imaging and prevention.
Baptist Health Medical Group is part of Baptist Health South Florida, the largest not-for-profit healthcare organization in the region. It includes Baptist Hospital, Baptist Children’s Hospital, South Miami Hospital, Doctors Hospital, Homestead Hospital, West Kendall Baptist Hospital, Baptist Cardiac & Vascular Institute, Mariners Hospital and Baptist Outpatient Services and Baptist Health Enterprises. Baptist Health Foundation, the organization’s fundraising arm, supports services at all hospitals and facilities affiliated with Baptist Health. For more information, connect with BaptistHealthSF on Facebook, Twitter and YouTube.