Can a polypill lower the risk of further strokes in the elderly?

Third Joint Stroke Association/BHF Programme Grant: does a 'polypill' have a role in secondary prevention of stroke in older people in the developed world? (third call)

After suffering a transient ischaemic attack (TIA) or a mini-stroke, 10 to 20 per cent of people go on to have a full stroke within a month. The risk of recurrent stroke is 30 to 43 per cent within five years. This risk can be substantially reduced by taking medication that reduces blood pressure and cholesterol. But doctors usually only prescribe an anti-platelet drug that reduces platelet clustering and the chances of a clot forming. This practice is particularly the case in older people who are also the most likely to have a stroke or TIA. Professor Jonathan Mant and his team will assess a polypill (where several drugs are combined into one tablet) that contains blood pressure and cholesterol lowering drugs with an antiplatelet drug. Professor Mant will assess whether the polypill is a more effective treatment than standard practice in older patients for preventing stroke recurrence. Evidence shows that, if patients take the three drug types individually and are careful to take all of them at the correct times and dosage (i.e. the optimal therapy), this is more effective than a polypill. But patients are not always prescribed the optimal therapy for different reasons or do not take the medication as advised. The first phase of research will involve studying prescription data relating to stroke patients, and a pilot trial of the polypill. The second phase involves examining how cost-effective a polypill is and running a full-scale clinical trial to compare it with current standard practice when trying to prevent a recurrence of strokes in the elderly. This research will inform future patient therapy and possibly demonstrate an improved strategy for preventing further strokes in older people. The cost-effectiveness element will give insights into the use of polypills in NHS policy. If results are positive the research could be broadened into other age groups.