The Multiconstituent Cardiovascular Pill (Mccp): Challenges And Promises Of Population Based Prophylactic Drug Therapy For Heart Attack Prevention And Eradication

Risk factors for atherosclerotic cardiovascular disease (CVD) are highly coprevalent but have been poorly identified and treated. The Screening for Heart Attack Prevention and Education (SHAPE) Task Force from the Society for Heart Attack Prevention and Eradication (SHAPE) has proposed a new strategy that recommends screening for subclinical atherosclerosis and implementing aggressive treatment of "vulnerable patients". The Task Force has also envisioned future developments that may shift mass screening strategies to mass prophylactic therapy. The "Polypill" concept, introduced by Wald and Law, suggests that a combination of statin, low-dose anti-hypertensive, aspirin and folic acid in a single pill taken prophylactically by a high risk population can cut CVD event rates by as much as 80%. In this communication, we review the challenges and promises of such a strategy. "Polypill" is but one of an almost infinite number of possible multiconstituent pills (MCCP). The MCCP concept, although attractive, lacks evidence from randomized controlled trials. The following need to be addressed: credibility of the concept, design and synthesis of such complex pills, pharmacokinetics, pharmacodynamics, bioequivalence, "class" vs. unique properties, interactions, clinical efficacy and safety, regulatory approval, post-marketing surveillance, prescription vs. over-the- counter use, responsibility for initiating and monitoring therapy, patient education, counterfeiting and importation, reimbursement, advertisement, patent protection, and commercial viability. If these issues are favorably addressed, MCCP is poised to dramatically alter the face of CVD prevention, particularly in developing societies. Universal adoption of highly effective, safe, and inexpensive MCCP has the potential to become a major public healthcare initiative in the movement for the worldwide eradication of heart attacks. Nonetheless, in the absence of commercial interests, realizing the promise of MCCP will demand serious attention from national public health policymakers.