Treatment of Population Risk
Wald and Law has taken the novel perspective that everyone over the age of 55 should take a pill containing medications to manage these issues irrespective of individual risk factor levels. The idea is that most people in Western Countries are at high overall risk, and the lowering risk factor levels will benefit all. Central to this is the realisation that risk factors are continuously associated with risk, and the dichotomies of, for example, "hypertension" and "no hypertension" have no scientific basis. Basically, the polypill could be used as a default medication for all people over 55 (or for others with comparable risks).
Currently, individual cardiovascular risk can be calculated based on the 50-year (and still going) longitudinal study on the population of Framingham, Massachusetts (the Framingham Heart Study). The polypill takes a population-based approach to management. The concept of "normal" and treatment thresholds becomes less relevant when taking a population-based approach to disease control. Traditionally, the approach has been to treat only if certain risk thresholds have been reached.
Paradoxically, even though an individual may not reach these traditional thresholds, benefit will still accrue by further reductions in blood pressure, cholesterol etc. This is because there is a sliding scale of risk; the concept of abnormal on one side of the line corresponding to high risk and requiring treatment, and normal on the other side, being low risk requiring no treatment is now under scrutiny.
Doctors will be treating population risk rather than individual risk factor thresholds as is current mainstream practice. So, if everyone was given the "Polypill" the average blood pressure and cholesterol levels within the population would fall, thus reducing overall population risk.
The "polypill" would contain three blood pressure medications at low dose:
- a diuretic, such as hydrochlorothiazide,
- a beta-blocker such as atenolol,
- an ACE inhibitor such as lisinopril.
This is combined with
- a statin such as simvastatin
- aspirin at a dose of 75 mg
- folic acid
Folic acid has been shown to reduce the level of homocysteine in the blood which is another risk factor for heart disease.
Read more about this topic: Polypill
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