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Ep. 6 - The Secret Behind the Polypill

Last week Dr. Chet discussed the difference between primary and secondary prevention of degenerative disease like cardiovascular disease and diabetes. Can something like a polypill reduce second heart attacks and strokes? What is a polypill? Dr. Chet explains on this episode of Straight Talk on Health

Welcome to Straight Talk on Health, I’m your host Dr. Chet Zelasko. On a recent podcast I discussed the difference between primary and secondary prevention of degenerative diseases like cardiovascular disease and diabetes. But one of the issues with prevention is having people stick to a plan. Even after a serious event like a heart attack. Lifestyle changes are challenging to stick with.

But so is something as simple as taking medications. Remember, this isn't to prevent a heart attack, it's the prevent a second heart attack. I can't think of anything that's more serious than that. Enter the polypill. You may be wondering: what is a polypill? Well I’ll get to that. But the concept of a polypill has been around for close to 20 years. The idea was to put medications together in one pill as a preventive that would reduce the risk of getting cardiovascular disease. In this case, it was for primary prevention. Researchers in Britain close to 20 years ago proposed a solution for reducing cardiovascular disease by more than 80%. How? With a polypill. So what they did is they examined the data in large clinical trials, and they determined that there were 4 risk factors for cardiovascular disease that were important to control. Now, this was a long time ago, but here they are. Low density lipoprotein cholesterol, sometimes called the bad cholesterol, although a lot of scientists don't like that nomenclature. Blood pressure, that seems obvious. Homocysteine levels. A Homocysteine is something that can be in your blood stream, but it needs to be dealt with, and it's dealt with by using folic acid to convert it into something else called methionine. Homocysteine: bad. Methionine: Good. Finally, platelet aggregation and that's clotting.

So what they proposed was a combination of pharmaceuticals and vitamins that could be used to control these risk factors and thereby reduce the morbidity rate 80%. Now, remember, morbidity is the disease rate. Mortality is the death rate, they were talking about that. So what would be in their polypill? A statin designed to reduce and to lower LDL cholesterol. Aspirin to prevent blood clotting. Folic acid, to reduce homocysteine levels. Three blood pressure medications. A diuretic, a beta blocker that helps reduce your heart rate. A diuretic helps eliminate fluids and then an angiotensin converting enzyme inhibitor often called an ace inhibitor, and all those 3 were designed to lower blood pressure.

Those medications combined in a single pill would be about one half the normal dose taken to treat disease. So the question is, how much would that be? Well, we know that we take 81 milligrams of an aspirin. So half that amount would be 40 milligrams and even today now, 20 years after they came up with this, even aspirin is being talked about as being removed from that list of medications that may help thin the blood. That's not for this show. It's a whole different conversation.

But the question then is this polypill, Who would take it? Everyone 55 years and older. Everyone. 55 years and older. Now If you think that fluoride in drinking water would cause an issue in Grand Rapids, Michigan, which was the original fluoridated city. What do you think this would do nationwide, especially in the atmosphere which we live today. But again, we're talking about 20 years ago. So the researchers understood that their view would be controversial. No kidding. But there will be years of clinical trials and debate before this polypill was available. But they also made a statement that goes a long way towards explaining why they took this approach. It should be recognized that in Western society, the risk factors are high in us all. So everyone is at risk. There's a lot of wisdom in that statement.

Think about it. We're all exposed to a fast food. We're all exposed to the interior of a grocery store. When we know the perimeter contains all the fruits and vegetables and milk and dairy and meat, etcetera, we're all exposed to those kinds of things. Plus, the stress of the life that we live in today. And so those are all risk factors. And this is going to help deal with the result of all of that. Well for a long time, that idea never went anywhere. But recently researchers decided to resurrect the concept. This time the objective was to monitor subjects recent heart attacks. In other words, our population pool is a group who's already had heart attacks. Would there be a difference in the rate of secondary events between subjects who took the polypill and those who took the same medications as individual pills? You can't responsibly deny someone a medication that may help them, but combining all 3 into 1 polypill and giving the other subjects the exact same medication. But individually as individual pills, there's nothing wrong with that because the treatment plan is the same. They would be getting the same amount in both types of medications.

Now after 3 years of follow-up, here are the results. The polypill experienced significantly fewer secondary events that would be secondary heart attacks. Myocardial infarction and strokes. 9.5% versus 12.7%. Now let me ask you a question before I give you the answer, can you figure out why the subjects who took the polypill did better than the subjects who took the same medications individually because they were all provided. So there was no cost issue involved.

You know, I'll tell you the secret to disease prevention in a, you know, a little bit of time. But let me say this, the reason was that it was all in one pill. That's still not a secret to it. They didn't come out and say that in their study, they were very conservative what they said. But I'm going to tell you why. That's it. Why the polypill work because people were more consistent in taking their medications than the subjects who took the exact same medications as individual pills. If you look at the data in this study, that is absolutely clear. The people that took the polypill just took it more consistently. They didn't ask the subjects whether is easier to remember to take one pill versus 3. These were people who are 75 years and older. So memory becomes an issue, which is one of the reasons they came up with the polypill. It's also easier to keep one medication refilled if it were talking about individuals not in the study rather than 3, but for whatever reason, the subjects just took their medication on a more regular basis. And the saw a decrease in recurrence of cardiovascular disease events.

Now, while this was a study about medication, it applies to reducing or changing your foods to eat healthier, reducing your risk of cardiovascular disease and diabetes or any other health goal. The secret the secret to the polypill was nothing more than you've got to be consistent, even getting a health benefit from taking a supplement. The dietary summer requires that you take it regularly for weeks or months to see some kind of benefit. We just don't seem to have that in us. And there's a special case in this: and that's weight loss. Losing weight and maintaining weight loss is the single most difficult things human beings can do. I know, I've been trying to do it for decades myself. Now, I don't weigh what I used to weigh but not where I want to be either.

Now I know many of you are probably in that spot as well. See, it's not the problem of losing the weight. It's the maintaining that's the issue. When you consider the simplicity of it, why is it so difficult to sustain a way of eating it keeps you at a healthy weight? Scientists and physicians have examined genetics, cardiomix. Cardiomix is study of the proteins that the body makes. Hormones and more. They've also looked at just about every psychological issue that they can think of to try to help people lose the weight and keep it off. So far, no luck. I'm going to go out on limb and predict there's not going to be any single answer. It's really up to each individual to find a way to eat that can sustain normal body weight. It will probably be slightly different for each and every one of us as to the types of foods and exercise we use.

But our solution exists. We just have to find a way to be consistent, or in the case of weight loss, it has to be for life. Look, now that you know the secret, and secret is consistency, we've got to overcome the obstacles in our path to health. We may not have the best genes, I know I don't. We may have had a poor lifestyle for many years that we've got to make up for, I do. We may not have all the resources that we need, but if we can just pick a couple of things at a time and make them our habits for life, we can begin the process. We just have to be consistent day in, day out, week in week out. Now where we end up may not be perfect, but I can assure you we can be better than where we are right now. And that's what aging with a vengeance is all about. Until next time this is Dr. Chet Zelasko saying health is a choice, people, choose wisely today and every day.

Narrator: Straight talk on health with Dr. Chet Zelasko was recorded in the studios of WGVU Public Radio in Grand Rapids, Michigan. The views and opinions expressed on straight talk on health are not necessarily those of WGVU, its underwriters, or Grand Valley State University. Episodes are found at wgvunews.org and wherever you get your podcast, please rate and subscribe.

Dr. Chet Zelasko is a scientist, speaker, and author. Dr. Chet has a Ph.D. and MA in Exercise Physiology and Health Education from Michigan State University and a BS in Physical Education from Canisius College. He’s certified by the American College of Sports Medicine as a Health and Fitness Specialist, belongs to the American Society of Nutrition, and has conducted research and been published in peer-reviewed journals. You can find him online at drchet.com.
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