Tag Archive for: polypill

The Secret to Prevention

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Consistency.

I thought I’d lead with the secret to disease prevention instead of making you wait. Whatever you want to accomplish in taking charge of your health, you have to be consistent. The polypill study proved it although the scientists, being conservative in their conclusions, don’t come out and say it—but I will. Here’s why.

Why the Polypill Was the Difference

The subjects taking the polypill were more consistent in taking their medications than the subjects who took the exact same medications as individual pills. They didn’t ask the subjects whether it was easier to remember to take one versus three pills; that could be a factor as the mean age of the subjects was over 75. It’s also easier to keep one medication refilled rather than three. Whatever the reason, the subjects just took their medication on a more regular basis and thus saw a decrease in recurrence of cardiovascular disease events.

While this was a study about medication, it applies to reducing or changing your foods to eat healthier, reducing the risk of cardiovascular disease and diabetes, or any other health goal: we have to be consistent. Even getting a health benefit from taking a supplement requires you to take it regularly for weeks or months to see a benefit.

Weight Loss: A Special Case

Losing weight and maintaining the weight loss is the single most difficult thing humans can do. I know. I’ve been trying for decades. I don’t weigh what I used to weigh, but I’m not where I want to be. I know many of you are in that spot as well.

It’s not the losing that’s the problem—it’s the maintaining. When you consider the simplicity of it, why is it so difficult to sustain a way of eating that keeps you at a healthy weight? Scientists and physicians have examined genetics, proteomics, hormones, and more. They have looked at every psychological issue they can think of to try to help people lose the weight and keep it off. No luck so far.

I’ll go out on a limb and predict there won’t be any one answer. It’s really up to each individual to find a way to eat that can sustain a normal body weight. It will probably be slightly different for each 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 and in the case of weight loss, it has to be for life.

The Bottom Line

We face plenty of obstacles in our path to health. We may not have the best genes. We may have had a poor lifestyle for many years that we have to compensate for. We may not have all the resources we need. But if we can 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. Where we end up may not be perfect, but it can be better than you are right now. That’s what aging with a vengeance is all about.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2022. DOI: 10.1056/NEJMoa2208275

Will the Polypill Reduce Second Heart Attacks?

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One of the issues with prevention is having people stick to a plan, even after an event as serious as 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 to prevent a second one. That’s serious.

The concept of a polypill has been around for close to 15 years. The idea was to put medications together in one pill as a preventive that would reduce the risk of getting cardiovascular disease. 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 with recent 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? The medications used were aspirin, ace-inhibitor, and a statin. After three years of follow-up, the subjects in the polypill experienced significantly fewer secondary events, 9.5% versus 12.7%.

Can you figure out why the subjects who took the polypill did better than the subjects who took the same medications individually? I’ll tell you the secret to disease prevention on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2022. DOI: 10.1056/NEJMoa2208275

Aspirin and Unintended Consequences

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We began the week considering a type of shortcut to health called biohacking. The polypill was a biohack to reduce the risk of CVD events, but there’s no research showing whether the polypill will ever prove to be effective. However, the results of the ASPREE trial may give us an idea whether the long-term trials should ever be attempted (1-3). Let’s take a look at the results of the ASPREE trial and the effects of an aspirin a day on healthy older adults.

In the first paper, the researchers evaluated the data to see if those who took the aspirin had less disability (1). In other words, did taking the aspirin convey benefits that reduced the risk of death, disability, or dementia? The data showed no differences between the aspirin and placebo group as it related to those outcomes.

In the second paper, the researchers examined the differences in all-cause mortality (2). What surprised the researchers was a slight increase in death from cancers in the group that took the aspirin; no specific type of cancer seemed to be impacted. Because aspirin has been shown to be beneficial in almost all other studies of cancer and mortality, the researchers said the results should be taken with a degree of caution.

In the final paper, researchers examined whether aspirin reduced the rate of CVD events and stroke (3) and found no difference, but the risk of hemorrhagic stroke was significantly higher in the aspirin group versus the placebo. This was the primary reason the study was terminated after five years.
 

The Problem

There were several problems with the study including the low adherence in both the aspirin and placebo group: if people didn’t take the pills, obviously that impacts the results. But the biggest question I have is a very simple one: who thought it was a good idea to give healthy people a medication every single day? Taking an aspirin for a headache or muscle ache is one thing. Taking it when you don’t need it is another.

The study demonstrated the logical fallacy of the polypill. “People won’t take care of themselves, so let’s put everyone on the medications that can reduce the risk of CVD.” No, let’s not. The results were unintended consequences that put the entire idea of biohacking into question.
 

The Bottom Line

When it comes to health, there are no real shortcuts. Biohacking, while a cute contemporary term, is fool’s gold. Yes, you can use your time and resources more efficiently to improve your health, but there are no shortcuts.

There is also one other obvious conclusion. Healthy people shouldn’t take medication. I take an 81 mg aspirin every day because I have had a stent and my doctor told me to. But I don’t take a statin any more because I changed my diet and lifestyle to keep my cholesterol normal. I control my blood pressure with diet and exercise. I don’t take medications I don’t need.

If you’re willing to do all you can to avoid medications and you still need medication to help you out, do it. But don’t take them to avoid doing the work. There are unintended consequences of taking the easy way out.

What are you prepared to do today?

Dr. Chet

 

References:
1. DOI: 10.1056/NEJMoa1800722.
2. DOI: 10.1056/NEJMoa1803955.
3. DOI: 10.1056/NEJMoa1805819.

 

An Aspirin a Day

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In Tuesday’s Memo, I talked about biohacking. Specifically, I talked about the idea of having everyone over a certain age take a pill that can impact the risk factors for CVD: high blood pressure, cholesterol, high heart rate, and blood cell stickiness. The idea is that taking that single pill in low doses every day might help reduce CVD events such as strokes and heart attacks.

Researchers in Australia and the U.S. decided to test one component of the polypill: aspirin. The study was called the Aspirin in Reducing Events in the Elderly (ASPREE) trial. They recruited over 19,000 people 70 and older or 65 if they were Black or Hispanic in the U.S. They randomly assigned half the subjects to take 100 mg of enteric-coated aspirin while the other half got a similar looking placebo. The subjects were tracked for an average of 4.7 years. The researchers examined many variables including mortality and the incidence of disease.

The results were published in three separate papers in a recent issue of the New England Journal of Medicine. The study was terminated after five years by the primary funding organization, the National Institute on Aging. The results were not exactly what was hoped. We’ll get into the details on Saturday. If you’d like to read the studies, all are available online at the links in the references.

What are you prepared to do today?

Dr. Chet

 

References:
1. DOI: 10.1056/NEJMoa1800722.
2. DOI: 10.1056/NEJMoa1803955.
3. DOI: 10.1056/NEJMoa1805819.