To treat cardiovascular disease, most of the available therapies often act on only one or few targets, depending on the symptoms apparent. However, cardiac pathologies encompass a very large set of conditions, all of whose symptoms are related. To provide effective relief to patients, doctors are often forced to recommend several treatments at the same time. A group of scientists tried to combine several existing drugs (three) treating different heart symptoms, into one. The large-scale clinical trial showed that the 3-in-1 drug is significantly more effective in preventing cardiac events (infarction, stroke, cardiac arrest, etc.) than tablets administered one by one.
Affecting the heart and the entire circulatory system, cardiovascular diseases include atherosclerosis, arrhythmia, high blood pressure, heart failure, etc. Although scientists are making great advances in therapeutic strategies, some patients still require the combination of several treatments at the same time, and this for life, to relieve their symptoms.
The treatments must in particular be combined, because a cardiac patient often requires intervention on all fronts. Take for example the case of a patient suffering from arterial hypertension, with underlying obesity. His hypertension would in this case be linked to atherosclerosis caused by high cholesterolemia. Its blood vessels cannot thus ensure normal blood flow, which greatly increases the mechanical tension in the arteries. And as the heart struggles to adapt naturally to try to normalize blood flow, the patient may also experience tachycardia (an excessively high heart rate) or angina pectoris (a feeling of pain in the heart due to decreased blood flow).
The patient would then need an anticoagulant to thin his blood enough to avoid the risk of obstruction by blood clot, and ensure normal blood flow. In parallel, it is also necessary to treat his atherosclerosis by lowering his cholesterol level with a cholesterol-lowering drug. It is also necessary to relieve the tension at the level of its arteries using a molecule regulating the constriction of the blood vessels, in particular by inhibiting the formation of angiotensin II (a vasoconstrictor hormone). Which is already three different drugs for a single patient.
In other cases, and especially the most serious ones, cardiologists can also add beta-blockers, in addition to these three treatments. These therapies notably inhibit adrenergic neurotransmitters and regulate heart rhythm. However, the body tends to adapt to such drugs, increasing the number of adrenergic hormone receptor cells in the heart. This phenomenon is especially observed in the cases of hypertrophic cardiomyopathies, where the volume of the heart of the patients sometimes increases in a spectacular way. This kind of inconvenience then forces doctors to readapt the dosage and combination of treatments for heart patients throughout their lives.
In order to design more effective therapeutic strategies, scientists have been thinking for some years regarding combining various therapies into one. The new study, detailed in the journal The New England Journal Of Medicine, proposed to test this strategy on a large scale, by combining an anticoagulant, a cholesterol-lowering drug and an angiotensin II converting enzyme inhibitor.
« The results of the SECURE study show, for the first time, that the polypill, which contains aspirin, ramipril and atorvastatin, achieves clinically relevant reductions in recurrent cardiovascular events in people who have recovered from a previous heart attack, due to better adherence to this approach, rather than taking the drugs separately conventionally », Explain Valentin Fuster, principal investigator of the new study.
A large-scale clinical trial
As part of its clinical trial, the research group recruited nearly 2,500 participants spread across seven different countries. Called Trinomia, the new drug combines aspirin, ramipril and atorvastatin, molecules often prescribed to heart patients. Participants were split into two groups, with one taking the polypill and the other taking the three drugs separately. The whole was then monitored over an average of three years.
At the end of the trial, the results revealed that the group taking the polypill was 33% less likely to die from a major cardiovascular event such as stroke or heart attack. Compared to the conventionally treated group, the Trinomia group also had a 24% lower risk of experiencing these major cardiovascular events.
According to the researchers, these results prove that patients are more likely to adhere to the single pill treatment, rather than taking three different drugs a day. However, it should be noted that the adverse effects remained the same in both groups of participants.
« Our goal was to make an impact early on, and most patients in the study started taking a simple polypill within the first week following having a heart attack. “, said Fuster. ” By simplifying treatment and improving adherence, this approach has the potential to reduce the risk of recurrent cardiovascular disease and death globally. “, he concludes.
