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The NHS could significantly reduce the number of heart attacks and strokes in the UK by offering a single “polypill” to everyone aged 50 and over, according to academics from University College London (UCL). The proposed pill would combine a statin with three blood pressure-lowering drugs, shifting the focus from disease treatment to prevention.
In an opinion piece published in The BMJ, the authors argued that a polypill program could serve as a “flagship strategy” in Labour’s commitment to proactive disease prevention. The proposal suggests using age as the sole criterion for eligibility, bypassing complex risk assessment tools that have proven ineffective in predicting cardiovascular events.
A Shift in NHS Preventative Strategy
The proposed polypill initiative would replace the NHS Health Check, a five-yearly assessment for individuals aged 40 to 74, which currently determines eligibility for cholesterol-lowering statins and blood pressure medication based on risk assessments. According to the authors, only 8% of eligible individuals need to take up the polypill offer to achieve a greater health benefit than the existing NHS Health Check program.
Their argument is supported by a landmark 2003 study that estimated a polypill for individuals over 55 could prevent about 80% of heart attacks and strokes. Subsequent clinical trials in multiple countries have reinforced these findings.
Experts Highlight the Potential Impact
Professor Aroon Hingorani from the UCL Institute of Health Informatics emphasized the limitations of the NHS Health Check, noting its low uptake—only four in ten people accept the invitation for an appointment. He also highlighted that many individuals who could benefit from medication do not receive prescriptions due to the shortcomings of current risk prediction models.
“Most heart attacks and strokes occur in people with average levels of risk,” Professor Hingorani stated. “A population-wide approach could prevent many more cases than the current strategy of targeting only high-risk individuals.”
He further noted that the drugs included in the polypill are off-patent, making them inexpensive. Additionally, extensive evidence has shown that statins have minimal side effects, while combining three blood pressure-lowering drugs at low doses increases their efficacy and reduces side effects.
Under the proposed scheme, individuals would be offered the polypill upon turning 50 without requiring a health check or test. A short questionnaire would be used to assess the risk of side effects, with further online assessments potentially required before repeat prescriptions.
Supporting Evidence from Global Trials
The authors referenced a 2019 randomized trial conducted in rural Iran, which found that taking a polypill for five years reduced heart attacks and strokes by a third. Additionally, a comparative analysis published in 2024 suggested that an optimal polypill program would provide more than twice the benefit in terms of life years free from cardiovascular disease compared to the NHS Health Check.
Professor Sir Nicholas Wald, co-author of the BMJ opinion piece, countered concerns that a polypill strategy would lead to unnecessary medication of a large segment of the population. He argued that it should be viewed as a preventative public health measure similar to vaccination programs, salt reduction in foods, and folic acid fortification in flour.
Next Steps: A Pilot Program and Policy Shift
The authors recommend launching a pilot project to determine how best to implement a national polypill program. The pilot would assess uptake rates, adherence, and cost-effectiveness. They also noted that local authorities, which are legally required to provide NHS Health Checks, would need government approval to transition to a polypill strategy.
“The status quo is not a justifiable option,” the authors concluded. “We have the means to prevent most heart attacks and strokes—far more than we currently do. All that is needed is to turn knowledge into action.”
The Burden of Cardiovascular Disease in the UK
Currently, more than seven million people in the UK are living with cardiovascular disease. Each year, approximately 100,000 people suffer a heart attack, while another 100,000 experience a stroke. The proposed polypill strategy has the potential to dramatically reduce these numbers and improve public health on a national scale.
Disclaimer
This article is based on an opinion piece published in The BMJ and reflects the views of the authors of that publication. Further research and policy discussions are required before any changes to NHS health programs are implemented.
