The NHS could prevent thousands more heart attacks and strokes every year by offering everyone in the UK aged 50 and over a single "polypill" combining a statin and three blood pressure lowering drugs, according to academics from UCL.
In an opinion piece for The BMJ, the authors argued that a polypill programme could be a "flagship strategy" in Labour's commitment to preventing disease rather than treating sickness. The programme would use age alone to assess eligibility, focusing on disease prevention rather than disease prediction.
They said such a strategy should replace the NHS Health Check, a five-yearly assessment for people aged 40 to 74 who are prescribed cholesterol-lowering statins if they are judged to have a higher risk of a heart attack or stroke, or given blood pressure lowering drugs if their blood pressure is above a certain threshold.
The new programme, the authors said, would only require 8% of those aged 50 and over to take up the offer of a polypill to achieve a bigger health benefit than the NHS Health Check*.
The authors pointed to a landmark paper in 2003, which estimated that a polypill for all over 55s could prevent about 80% of heart attacks and strokes. They argued its conclusion was supported by clinical trials that had taken place in the years since in several countries.
Co-author Professor Aroon Hingorani (UCL Institute of Health Informatics) said: "The NHS Health Check isn't working very well. Uptake is low, with only four in 10 people taking up the offer of an appointment. Lots of people who would benefit from medication are not prescribed it.
"What is more, our complex risk prediction tools are not very effective. They do not predict very well who will get a heart attack or stroke. That is because most heart attacks and strokes occur in people with average levels of risk.
"Now is the time to do much better on prevention. A population-wide approach could prevent many more heart attacks and strokes than the current strategy of targeting a more limited group only."
Professor Hingorani added: "A polypill programme would be a simple, effective, and potentially low-cost strategy. The drugs are off patent so inexpensive. Many years of evidence show statins are low risk, with minimal side effects, while combining three blood pressure lowering drugs at low dose reduces these drugs' side effects and increases their benefits.
"People could receive an offer of a polypill once they turn 50. They would not need a health check or test but only to answer a few questions to assess their risk of side effects. Further assessments via an online questionnaire could be required before the prescription is repeated."
In their piece, the authors pointed to a randomised trial in rural Iran, whose findings were published in 2019, showing that a polypill taken for five years reduced heart attacks and strokes by a third.
In analysis* published last year, the authors compared optimal take-up of the NHS Health Check and a polypill programme (where everyone offered both a check and medication took them up). They found that the polypill approach would have more than twice the benefit in terms of years of life free of heart attacks and strokes that would be gained as a result.
Co-author Professor Sir Nicholas Wald (UCL Institute of Health Informatics) said: "Rather than being a 'medicalisation' of a large section of the population, a polypill programme is a preventative strategy designed to avoid a person becoming a patient. It can be compared to public health programmes such as vaccinations, reducing salt in food and adding folic acid to flour."
In the opinion piece, the authors said the next step would be a pilot project to see how a national programme could best be carried out and to evaluate uptake, adherence and cost.
As local authorities have a statutory obligation to provide an NHS Health Check, they wrote, a directive would be needed to give authorities permission to replace the health check with a polypill programme.
"The status quo is not a justifiable option," the authors concluded. "We have the means of preventing most heart attacks and strokes, many more than are currently being prevented. All that is required is to translate what we know into action."
The opinion piece was based on discussions at a consensus-building seminar organised by the authors that involved eminent health experts from a range of fields, including cardiologists, neurologists, epidemiologists, pharmacologists, statisticians, and policymakers.
In the UK more than seven million people are living with cardiovascular disease. Around 100,000 people have a heart attack and more than 100,000 people have a stroke every year.
* https://pmc.ncbi.nlm.nih.gov/articles/PMC11083722/#fig1-09691413241235488
