
Four-in-one pill prevents third of heart problems: study - known
https://www.bbc.com/news/health-49434337
======
drcode
A read through of the methodology makes it sounds like they took solid
precautions to prevent biases that could taint the results- As an MD, I'm
impressed by the design of this study, and the promising results.

This may be what more studies in the future will look like: Bundle multiple
interventions together to help create statistically stronger results, at the
cost of less clarity around each individual treatment.

EDIT: Someone else on HN noticed there possibly was no placebo for the control
group- This worries me. Also, there's no indication in the methodology that
the "field team" was blinded as to treatment groups :(

~~~
vanderZwan
> _This may be what more studies in the future will look like: Bundle multiple
> interventions together to help create statistically stronger results, at the
> cost of less clarity around each individual treatment_

I'm probably stating the obvious, but it may also be that multiple
interventions together have a larger net effect than the interventions
separately would suggest. I recently read an article by a physician arguing
for many of his patients, treating ADHD with a combination of a stimulant and
a non-stimulant resulted in bigger benefits with less side-effects, due to
being able to have a lower dosage for each individual medication[0].

[0] [https://www.additudemag.com/adhd-medication-combination-
ther...](https://www.additudemag.com/adhd-medication-combination-therapy-
treatment/)

~~~
drcode
I agree that synergy is an important element, but to me a study like this
could make sense even without synergy: To me, it seems better to have 4x the
statistical data on 4 drugs at once than just running the individual studies,
given how long a study like this takes.

------
JanSt
> Half the people were given the polypill and advice on how to improve their
> lifestyle, with the other half just getting the advice.

Why didn't the other half get a placebo? Or is this sloppy editing?

Not only do they miss the placebo effect but also the daily reminder to
improve their lifestyle (pill as anchor)

~~~
snosons
That's a great point about the pill as a daily reminder -- the control and
intervention groups otherwise received healthy lifestyle training every 6
months.

------
sp332
Did the study include looking at side effects or other causes of death besides
strokes and heart attacks? Low-dose aspirin alone is dangerous enough that
it's probably not worth taking unless you have some other risk factors for
heart problems. [https://www.health.harvard.edu/heart-health/is-low-dose-
aspi...](https://www.health.harvard.edu/heart-health/is-low-dose-aspirin-safe-
for-you)

------
snosons
According to the abstract[1], the polypill contains hydrochlorothiazide 12.5
mg, aspirin 81 mg, atorvastatin 20 mg, and either enalapril 5 mg or valsartan
40 mg.

1:
[https://www.thelancet.com/journals/lancet/article/PIIS0140-6...](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(19\)31791-X/fulltext)

------
Gys
The four-in-one pill is known as the 'Polypill'.

Related:
[https://www.ncbi.nlm.nih.gov/pubmed/15604180](https://www.ncbi.nlm.nih.gov/pubmed/15604180)

'The Polymeal: a more natural, safer, and probably tastier (than the Polypill)
strategy to reduce cardiovascular disease by more than 75%'

~~~
neuronexmachina
It actually sounds pretty tasty:
[https://en.wikipedia.org/wiki/Polymeal](https://en.wikipedia.org/wiki/Polymeal)

> They suggest a person should consume, every day: 150 mL of red wine (about
> one glass), 100 g of dark chocolate, 400 g of fruits and vegetables, 2.7 g
> of garlic, 68 g of almonds, as well as 118 g of fish per day four times each
> week.

------
simplecomplex
Proper diet, exercise, and avoiding smoking also prevents more than a third of
heart problems. It’s safer than blood-pressure or cholesterol medications.

~~~
nobleach
I'm awfully confused why anyone would downvote this response. It seems like
completely sane advice. Is it the smoking thing?

~~~
Someone1234
It is snark. It isn't meant to be constructive or add value to the thread, it
is meant to condescend by saying something true but using that truism in order
to imply it is also easy (in spite of all of the evidence to the contrary).

To quote the site's guidelines:

> Be kind. Don't be snarky. Comments should get more thoughtful and
> substantive, not less, as a topic gets more divisive.

It is snarky. It isn't thoughtful or substantive.

~~~
switchbak
It is rather knee-jerk dismissive, true. Snarky? I'm not sure I have the
evidence to claim that.

They do have a good point, but the discussion is obviously more nuanced than
that. People generally know that exercise is good for them, yet many/most
people don't engage in it to a healthy degree. So some discussion of other
approaches is appropriate. Let's not make "the perfect the enemy of the good"
and all that.

And we don't need to be either/or here. For individuals that have even a
moderately elevated risk, doing both is probably a great idea (and of course
this is already broadly recommended advice). Doing just one would still be
better, and most people would choose a pill over exercise. Still a win in my
book.

------
rubicon33
There will be a time in the future, when we look back on pills as a laughably
crude form of treatment, similar to how we look back on bloodletting now.

Take X pill to solve Y, but side effect(s) are Z.

Your best bet in life now is to invest in your health early. It's a
compounding effect. Walk regularly. Exercise. Eat healthy (mostly vegetables,
fruit, reduce animal products). Sleep well.

~~~
TheSoftwareGuy
I don't want to downplay the importance of investing in your health early, but
I generally disagree with the sentiment. Pills are possibly the best form of
treatment that exists (so long as there is a pill that can treat your
condition, like there's no pill to treat a severed finger).

People have been taking medicines for mellenia, and pills are just medicine
that has been measured and packaged in a convenient way. Its the difference
between telling patients "Go find a willow tree and eat some of its bark" vs.
"take two aspirin".

~~~
rubicon33
I don't disagree that they're the best form of treatment right now. I can see
how the tone of my post definitely disregards the importance of pills right
now.

I just feel like they are a disappointing "solution" to a yet fully understood
problem. I'm hopeful that we (humanity) continue to invest in real cures,
rather than treatments that often come with side effects.

~~~
TheSoftwareGuy
I think you are disappointed in the practice of treating symptoms when no cure
is available, rather than disliking pills as a delivery mechanism for
medicine, which is how your first comment reads.

It's entirely possible that some diseases will be cured by pills, as they are
just a delivery mechanism for medicine (and I would like to reiterate they are
pretty great at that).

To your main point about treating symptoms vs. creating cures, yes its pretty
unfortunate. But most likely, we will be finding cures for diseases one at a
time, and there will always be conditions where we can only treat the
symptoms.

