A Preventive Cocktail

Take one a week and call back when you�re 90.

JEFF MILLER

A universal pill to prolong life sounds like a medicine show nostrum. But the mountebanks� cry has lately been taken up by a group of doctors who claim that a �polypill� of basic drugs could add years to the average Western life. Critics say that optimism has again gotten the better of sense, setting off a brisk debate about the nature of preventive medicine.

The case for the polypill is straightforward as presented by Nicholas Wald, head of the Department of Environmental and Preventive Medicine at the Wolfson Institute of Preventive Medicine in London, and his associate Malcolm Law in a recent article in the British Medical Journal.¹ Heart attacks and strokes kill 2.5 million people in the United States and Western Europe every year, and they diminish the quality of life for many more who survive them. Reduce those numbers, and you can both extend and improve many people�s lives. Based on an analysis of 750 clinical trials and cohort studies involving 400,000 patients, the authors reckon that a combination of six drugs would do it.

Dr. Wald and Dr. Law�s polypill�s ingredients are all well known and available generically: aspirin, folic acid, a cholesterol-lowering statin, and three blood pressure drugs at half doses. Together they attack four risk factors for cardiovascular disease: low-density lipoprotein cholesterol, high blood pressure, elevated serum homocysteine, and platelet aggregation. If everyone started to take it at the age of 55, says Dr. Wald, the polypill would �have a greater impact on the prevention of disease in the Western world than any other single intervention.�

Cardiovascular disease is not only a killer, it�s expensive. In 2001, the United States spent $300 billion responding to strokes and heart attacks. As the rich world becomes more obese, that figure will keep growing. Overweight older people will still fall ill and die of something, but the polypill could help postpone the fatal day. As Dr. Wald says, �the main effect of taking a polypill daily would be to delay death from cardiovascular disease for so long that you would likely die of something else first.�

1  Wald, N.J., M.R. Law (June 28, 2003) A strategy to reduce cardiovascular disease by more than 80%. British Medical Journal 326:1419.