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[NEW DELHI] A five-in-one pill that reduces heart disease has raised expectations of a convenient remedy, but experts caution that it will not replace the benefits of a healthy diet and regular exercise.

Scientists from India and Canada tested a single 'Polycap' formulation that combines three widely-used drugs to reduce high blood pressure, with a statin to reduce cholesterol levels and aspirin to prevent blood clotting.

They tested the formulation in over 2,000 people between 45 and 80 years old who had no previous heart disease but one risk factor for it, such as diabetes, high blood pressure or smoking, across 50 centres in India. Ahmedabad-based Cadila Pharmaceuticals funded the trial.

The five-in-one drug formulation reduced blood pressure, harmful cholesterol and blood clotting, and was as safe as the individual drugs, a report published in The Lancet last month (30 March) says.

Chronic diseases are rising in developing countries. India has the highest number of diabetes patients in the world, with 40 million cases. Recent studies show obesity is soaring in China (see Study finds Chinese obesity rates soaring) and heart disease is rising in South Africa (see Heart disease 'on the rise in black Africans').

Experts treating these diseases in India, however, caution that while the 'polypill' is promising, it should not lead to complacency.

Questions that need to be addressed include whether all five drugs are needed in all cases, whether healthy people will or are able to take the pill daily for several years, and whether people will become complacent and ignore the need for healthy diet and daily exercise, Anoop Misra, director of the Centre for Diabetes and Metabolic Diseases at Fortis Hospitals and formerly of the All India Institute of Medical Sciences in Delhi, told SciDev.Net.

Misra says the most cost-effective and best methods to decrease heart attacks, particularly in developing countries, are healthy diet and regular exercise.

Muthuswamy Balasubramanyam, assistant director at the Madras Diabetes Research Foundation in Chennai, a WHO collaborating centre for diabetes research, says there can be several problems while deciding on such single remedies.

Potential drug interactions, differences in drug metabolism in individuals and underlying causes of disease that differ between patients may require individualised therapy. "For a polypill, frequent monitoring and blood tests may be required," he says.

The 'polypill' should not divert funds and energy from health promotion measures such as stopping smoking, healthy food choices and physical activity, he cautions.

Link to summary of paper in The Lancet