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CNN Saturday Morning News
"Weekend House Call": Could Polypill Almost Eliminate Nations Leading Killer
Aired June 28, 2003 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
KRIS OSBORN, CNN CORRESPONDENT: This is "Weekend House Call." Could there soon be a pill that would almost eliminate the nation's number one killer? Have researchers in London found a fountain of youth of sorts? Or is this news just too good to be true?
I'm here with CNN's Dr. Sanjay Gupta, someone you know.
We'll be talking about the so-called polypill. And if you're wondering about what this is, what it might mean, what all the possible repercussions might be, Dr. Gupta has you covered, I guarantee it.
DR. SANJAY GUPTA, CNN CORRESPONDENT: Yes, lots of...
OSBORN: My intuition tells me that, doctor.
GUPTA: We've got a lot to talk about today, no question.
Doctors announced just this week that there may soon be a pill that could prevent over 80 percent of all heart attacks and strokes. We're going to talk about that. We're going to really work through it today on "Weekend House Call."
We're also going to be talking about other things you can do today to reduce your risk of a heart attack. That's the number one killer for men and women.
Let's start, though, with the polypill.
(BEGIN VIDEOTAPE)
GUPTA (voice-over): On average, most people in their 60s and 70s take five to seven pills every day. They take them to lower cholesterol, improve blood pressure and generally promoted good health. But what if there was just one pill, a polypill? And instead of waiting until you get sick to start it, you took it every day starting at age 55 as a preventive, even if you were completely healthy?
DR. NICHOLAS WALD, POLYPILL RESEARCHER: In people who start taking the polypill at age 55, about one third would expect to benefit. And each of those individuals will, on average, gain about 12 years of extra life. Now, that is enormous.
GUPTA: Researchers say that it can reduce your risk of heart attack and stroke, the biggest killers of men and women, by 80 percent or more. The pill would contain cholesterol lowering statens, blood pressure drugs, folic acid and aspirin.
The ingredients would work together to combat the four major markers of heart disease, including cholesterol and hypertension.
Sound too good to be true? Well, the American Heart Association says that in theory the polypill should work, but probably only for some people, the high risk ones.
UNIDENTIFIED MALE: I think it would work in terms of providing some core medications that would clearly lower risk of second heart events in people who've had heart disease or stroke and for selected patients who have elevated risk factors for heart disease. The combination is logical.
GUPTA: A logical combination that might have risks in an estimated eight to 12 percent of people, such as risk to the liver, stomach irritation or just general fatigue. And the polypill is likely years away. Pharmacologists need to develop it and researchers need to make sure it's safe. But it may prove the old adage true, an ounce of prevention really is worth a pound of cure.
(END VIDEOTAPE)
GUPTA: All right, now the strategy of the polypill is to reduce your LDL -- that, of course, is your bad cholesterol -- reduce your blood pressure, bring down something known as homocystine levels, which also increase your risk of heart disease, and also to inhibit blood clotting, which can cause heart attacks, all things that should reduce your risk of having heart attacks.
Now, if you have questions about the polypill or other questions about keeping your heart healthy, we want you to call us. That's at 800-807-2620. I will say international charges may apply for some overseas callers.
Or you can e-mail your questions at housecall@cnn.com.
And to help answer your questions, we're joined by a couple of very interesting guests today. First of all, the polypill researcher himself, Dr. Nicholas Wald, is joining us from London. And a cardiologist right here in the United States, Dr. Herb Arnow. He's at the Cleveland Clinic, soon to be at the University of Pennsylvania.
Thanks both of you very much for joining us this weekend.
DR. HERB ARNOW, CARDIOLOGIST: Good morning, Sanjay.
Thank you.
GUPTA: All right.
Let's get first right to our first e-mail. We're getting a lot of those coming in. Richard in Florida writes, "The heart attack pill" -- he's calling it the heart attack pill -- "what's in it?"
Dr. Nicholas Wald? WALD: Hello.
GUPTA: What do you think about that question?
WALD: You're asking me what's in it?
GUPTA: That's right. That's the first e-mail question.
WALD: You're asking me for the components. There's six components. There are three blood pressure lowering agents at half usual dose. By having them at half dose, one doesn't lose efficacy, but one much reduces the side effects. There's also aspirin, staten and folic acid to lower homocystine.
GUPTA: All right, and Dr. Arnow, you're a cardiologist, obviously, here, as well. Your first reaction when you heard about this polypill, this sort of combination medication to prevent heart disease. What were you thinking?
ARNOW: I think the study is very provocative. Frankly, I was excited when I heard about it. The idea that we could take everything but the kitchen sink and throw it into a single pill for patients, I think, has tremendous appeal for patients and for patients or for people who are at risk of developing disease. I think that I want everyone to realize at this point this is still an idea. It's an untested idea. And so I certainly am somewhat skeptical, since we don't really know whether the benefits would be realized and, if so, to what extent. And we also don't know whether the risks would be as low as the authors suggest.
Nevertheless, I think to take a serious look at this was well needed and I commend the authors on that.
OSBORN: Well, on this very topic we want to start...
WALD: Can I come in here?
OSBORN: ... answering some of your viewer phone calls. And right now we have on the line Janis from Knoxville.
Hello to you.
Welcome.
And your question for Dr. Gupta?
JANICE: Thank you for taking my call.
OSBORN: Sure.
JANICE: And I have a son that was 47 years old. He's had a slight heart attack and he has two stents in. One has been closed and they cannot open it. Would this help him at his stage?
GUPTA: OK, well, that's an interesting question. And actually Dr. Arnow, maybe to you, this is obviously somebody who already has existing heart disease. We'll get Dr. Wald to jump in. But first, Dr. Arnow, what do you say to someone like that?
ARNOW: Sure. First, I would say for people who have heart disease, most of the components of this pill have already been established to be beneficial, that is, we know aspirin, perhaps. Although we're not certain about folic acid, we know statens for certain, and we know in many people with heart disease blood pressure lowering medications are beneficial. So there's no question about that.
Your question, though, was specifically about someone who has a stent. That is a metal scaffold in one of their heart arteries and a stent that's now closed. Would this medication help?
These medications won't reopen the stent. If it's possible to do that, it would have to be done mechanically, that is, with something referred to as angioplasty. Sometimes, though, angioplasty isn't the right answer and the only way to fix that is surgery.
GUPTA: And Dr. Wald, obviously the question was about a patient who already has existing heart disease. Who is the target population for this polypill? Who's the most likely candidate to use this and benefit from it?
WALD: Well, two groups, people with existing heart disease. So this individual would benefit from this combination. But as Herb pointed out, it may not be sufficient because there is an additional problem that needs to be sorted out specifically and I can't clearly comment on that individual case.
But certainly anyone with existing cardiovascular disease would benefit, with diabetes mellitus and all adults from the age of 55.
I think I should point out that the evidence in support of the polypill and its components is based on many hundreds of trials and hundreds of thousands of patients. It's not a speculation or a hypothesis. It's based upon firm evidence. For three of the mechanisms that's lowering blood pressure, lowering cholesterol and reducing platelet stickiness, the evidence is cast iron. The evidence on folic acid for reducing homocystine is very strong, but not quite so solid.
But of all the components, that's the one that has the least effect. So I do think it's important that the public are aware that this is not a speculation. It is firmly based on evidence and the three papers in the British medical journal document that evidence.
OSBORN: Well, and as some of the doctors were referring to, there is an interesting question here. Even if there is a magic pill in our future, should we take steps today to reduce our risk of dying early?
We will look at the impact of food and exercise on our heart and take more of your calls and e-mails
GUPTA: And you can call us, as well, 800-807-2620 or fire off an e-mail, as Chris said. That's housecall@cnn.com. We're coming right back. Lots of discussion. Don't go away.
COMMERCIAL
GUPTA: You're watching CNN's "Weekend House Call."
Our topic today, your heart. And you may be at home wondering could you yourself be at risk of a heart attack? Well, if you're not sure, go to cnn.com/health. There you can read our story on the polypill. You can also click on a link to the American Heart Association, where if you answer just a few questions, you can determine your risk of having a heart attack in the next 10 years.
OSBORN: And if you are at home wondering, as the doctor said, we are taking your questions about your heart and how to keep it healthy today and in the future. You can call us right here, 800-807-2620. And before we go to the break, let's check our daily dose health quiz.
Listen to this one. Interesting question. How many people are diagnosed with heart disease in the U.S. every year? We'll have the answer in 30 seconds. Stay tuned for it.
COMMERCIAL
GUPTA: Welcome back to CNN our "Weekend House Call."
We've been talking about the polypill.
A couple of things. A lot of people are asking about potential side effects by combining all these different medications. Six different medications, again. Look at the list here -- liver problems possibly as a result of the staten medications; stomach irritation as a result of the aspirin and then dizziness, fatigue and headaches.
Well, besides keeping your fingers crossed that the polypill will save us all, there are things you can do, as well, to try and lower your risk of having a heart attack and heart disease. These are obvious ones. Everybody already knows these. Stop smoking, get more exercise, control stress, limit alcohol consumption and lower the fat in your diet.
Those are the knowns. We already know that.
Of course, that leads us to our next e-mail. A viewer from New Jersey writes, "I'd like to know if Americans in particular are more prone to heart disease than people residing in other countries as a result of our unhealthy food habits."
We talk a lot about that. Dr. Arnow is a cardiologist here in the United States.
What do you think about that, the idea that American citizens are a little bit more a target population here than other countries around the world?
ARNOW: I think it's fair to say that either sclerosis or plaque built up in the arteries affects everyone worldwide. But you're right that Americans, as a group, have higher rates. Whether that's our lifestyle or, in part, some of our genetics, it's hard to say. But I think a lot of it is the former, is what we do.
OSBORN: All right, we are now going to talk to Ed from Texas, who joins us on the phone with a question in this morning's "Weekend House Call" for Dr. Gupta.
Good morning to you, Ed.
ED: Good morning.
Thanks for taking my call.
OSBORN: It's a pleasure.
ED: As you said, the polypill is several years away. "Consumer Reports" last month had an article that suggested that natural fish oil concentrate in a dosage of about 1,000 milligrams a day would be beneficial for your entire cardiovascular system. I'd just like your reaction to that.
GUPTA: Well, that's an interesting question. And Dr. Wald, I'm going to throw this one over to you. Again, you mentioned the six components of this particular pill. What about fish oil? Was that something you considered?
WALD: Well, fish oil is generally regarded as beneficial. I'm not sure -- I mean the evidence needs to be firmed up quite a bit. And I'm not sure about the particular does that's been referred to. But in general, fish oils are regarded as a healthy form of nutrition.
GUPTA: OK.
OSBORN: Well, do you know the warning signs of a heart attack? We will talk about that very question and answer more of your phone calls and e-mail questions on this very significant health issue. That's coming up with Dr. Gupta right when we get back.
COMMERCIAL
GUPTA: Welcome back to "Weekend House Call."
We've spent some time this morning giving you some tips and strategies for a healthy heart. But what if you do have a heart attack? Would you know the warning signs? It's not always as it appears in the movies. It could just be some chest discomfort, pain in the arms, back or neck, shortness of breath, cold sweats or nausea.
We've been talking a lot about polypill this morning and we want to delve a little bit deeper into the issue again. Our guests, Dr. Nicholas Wald from London, Dr. Herb Arnow from Cleveland.
Just a couple of thoughts about this.
First of all, Dr. Wald, to you again, would this pill sort of get rid of the need to -- for people to live a healthy lifestyle? I think a lot of people are at home saying this is great. This pill is going to come out and when I turn 55 I just start popping this pill and I don't have to worry about all the other things that have been drilled into our heads for so many years.
WALD: No, it wouldn't. It's not an alternative to the avoidance of smoking and the control of weight. It's a complementary measure, preventive measure. And all it's really doing is applying the well recognized treatments for people who have already had a heart attack to people before they get it. So it's a form of primary prevention. It's using the same drugs to prevent the same events happening in the first place rather than just treating people who've already had an event.
OSBORN: So, Dr. Wald, Kris Osborn here. So I understand the intention or the idea is with this pill to take it in conjunction with doing other things that doctors such as yourself would recommend -- exercise, eating healthy, things like that.
WALD: Yes, reasonable exercise, reasonable diet. I mean what it would do is you don't have to be quite so obsessional over diet. You could have cheese from time to time. But you certainly should control your weight and one should certainly avoid smoking. So the measure, the polypill is in no way an alternative to these things. It's additional to them.
GUPTA: And Dr. Arnow, you've been a little bit skeptical, hearing your comments this morning. You know, when people talk about -- again, we talked about the fact that people know the right things to do to stay heart healthy and to avoid their risk, reduce their risks of certain diseases processes. Do you think a pill like this -- is it going to have a role? Or do we just need to focus on the fundamentals when it comes to our health?
ARNOW: Well, Sanjay, I think both are true. I think certainly we can't advocate pharmacotherapy, that is, medications, before we tell people to get off the couch and exercise, to eat right and to put the cigarettes down.
That being said, there are certainly people who despite doing all of those things will still need treatment and who may need medications and vitamins for prevention. That may be where the polypill comes into play. And I think in those higher risk populations it's certainly worth testing that idea. I'm just skeptical about using it as a blanket treatment for everyone over 55.
OSBORN: Well, let's bring Barb from Ontario into the conversation. She joins us now on the phone.
Good morning to you, Barb.
Glad you're on with us.
BARB: Good morning.
OSBORN: Sure. BARB: I would like to ask the doctors, I am currently on all those medications, with the exception of the cholesterol lowering and I just wondered if what I'm doing is the right thing now by taking everything on an individual basis.
GUPTA: Well, you know, this is an important point. Let me make a distinction really quick. On one hand, what the polypill is talking about is actually treating people before they get sick. What happens typically to most people is they wait till they -- people wait till they get sick before they start these medications.
Dr. Wald, what do you say to someone like this? She's already taking these medications.
WALD: Yes, I mean this is often the case, that one, during life, as one gets old enough, one winds up by taking many of the components. I would say that it's worth considering adding a staten because if you're on all the others, you must be judged to be at risk of cardiovascular disease and a staten is a very effective means of reducing your risk of a heart attack.
So by all means speak to your doctor and ask him whether he thinks you should go on the staten as well as the others.
GUPTA: And I should mention, as well, as part of the study that Dr. Wald conducted, he's saying, you know what? We would no longer need to do all these tests, we no longer need to get angiograms and all that sort of stuff for your heart. People would just start taking this pill at age 55, everybody would start taking it to try and prevent this thing. And it's obviously a very controversial subject.
We're going to get final thoughts from both doctors as well as myself when we come back in just a minute.
COMMERCIAL
GUPTA: Well, a very provocative show today on the polypill.
We want some final thoughts from both of our guests.
First, Dr. Nicholas Wald, the research on this topic.
He joins us from London.
Final thoughts, sir?
WALD: Io think three points. The expected impact is very great, preventing over 80 percent of heart attacks and strokes. Two, most heart attacks and strokes occur with people with about average cholesterol and blood pressure levels, so it's a mistake to just target those with raised levels. Everyone is at risk once they're old enough. And the last point is given that one can effectively prevent second events by treating people with disease, why not prevent first events by offering the treatment earlier?
GUPTA: Good point, sir. Thank you very much for joining us from London.
And Dr. Herb Arnow from Cleveland, a final thought, sir?
ARNOW: I also have three points, Sanjay.
The first is that everyone needs to eat right, exercise and stop smoking if they do. The second is that if you're at risk for, elevated risk for or already have cardiovascular disease, then the medications in the polypill may very well be right for you, at least alone. Whether they're right in combination remains to be seen. And finally, I think you need to see your doctor regularly for the detection and treatment of risk factors for cardiovascular disease. I don't think that putting people on a pill and on autopilot is the way to go.
GUPTA: All right, thank you both, gentlemen.
A very interesting show.
And CNN SATURDAY MORNING continues right now.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com
Nations Leading Killer>
Aired June 28, 2003 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
KRIS OSBORN, CNN CORRESPONDENT: This is "Weekend House Call." Could there soon be a pill that would almost eliminate the nation's number one killer? Have researchers in London found a fountain of youth of sorts? Or is this news just too good to be true?
I'm here with CNN's Dr. Sanjay Gupta, someone you know.
We'll be talking about the so-called polypill. And if you're wondering about what this is, what it might mean, what all the possible repercussions might be, Dr. Gupta has you covered, I guarantee it.
DR. SANJAY GUPTA, CNN CORRESPONDENT: Yes, lots of...
OSBORN: My intuition tells me that, doctor.
GUPTA: We've got a lot to talk about today, no question.
Doctors announced just this week that there may soon be a pill that could prevent over 80 percent of all heart attacks and strokes. We're going to talk about that. We're going to really work through it today on "Weekend House Call."
We're also going to be talking about other things you can do today to reduce your risk of a heart attack. That's the number one killer for men and women.
Let's start, though, with the polypill.
(BEGIN VIDEOTAPE)
GUPTA (voice-over): On average, most people in their 60s and 70s take five to seven pills every day. They take them to lower cholesterol, improve blood pressure and generally promoted good health. But what if there was just one pill, a polypill? And instead of waiting until you get sick to start it, you took it every day starting at age 55 as a preventive, even if you were completely healthy?
DR. NICHOLAS WALD, POLYPILL RESEARCHER: In people who start taking the polypill at age 55, about one third would expect to benefit. And each of those individuals will, on average, gain about 12 years of extra life. Now, that is enormous.
GUPTA: Researchers say that it can reduce your risk of heart attack and stroke, the biggest killers of men and women, by 80 percent or more. The pill would contain cholesterol lowering statens, blood pressure drugs, folic acid and aspirin.
The ingredients would work together to combat the four major markers of heart disease, including cholesterol and hypertension.
Sound too good to be true? Well, the American Heart Association says that in theory the polypill should work, but probably only for some people, the high risk ones.
UNIDENTIFIED MALE: I think it would work in terms of providing some core medications that would clearly lower risk of second heart events in people who've had heart disease or stroke and for selected patients who have elevated risk factors for heart disease. The combination is logical.
GUPTA: A logical combination that might have risks in an estimated eight to 12 percent of people, such as risk to the liver, stomach irritation or just general fatigue. And the polypill is likely years away. Pharmacologists need to develop it and researchers need to make sure it's safe. But it may prove the old adage true, an ounce of prevention really is worth a pound of cure.
(END VIDEOTAPE)
GUPTA: All right, now the strategy of the polypill is to reduce your LDL -- that, of course, is your bad cholesterol -- reduce your blood pressure, bring down something known as homocystine levels, which also increase your risk of heart disease, and also to inhibit blood clotting, which can cause heart attacks, all things that should reduce your risk of having heart attacks.
Now, if you have questions about the polypill or other questions about keeping your heart healthy, we want you to call us. That's at 800-807-2620. I will say international charges may apply for some overseas callers.
Or you can e-mail your questions at housecall@cnn.com.
And to help answer your questions, we're joined by a couple of very interesting guests today. First of all, the polypill researcher himself, Dr. Nicholas Wald, is joining us from London. And a cardiologist right here in the United States, Dr. Herb Arnow. He's at the Cleveland Clinic, soon to be at the University of Pennsylvania.
Thanks both of you very much for joining us this weekend.
DR. HERB ARNOW, CARDIOLOGIST: Good morning, Sanjay.
Thank you.
GUPTA: All right.
Let's get first right to our first e-mail. We're getting a lot of those coming in. Richard in Florida writes, "The heart attack pill" -- he's calling it the heart attack pill -- "what's in it?"
Dr. Nicholas Wald? WALD: Hello.
GUPTA: What do you think about that question?
WALD: You're asking me what's in it?
GUPTA: That's right. That's the first e-mail question.
WALD: You're asking me for the components. There's six components. There are three blood pressure lowering agents at half usual dose. By having them at half dose, one doesn't lose efficacy, but one much reduces the side effects. There's also aspirin, staten and folic acid to lower homocystine.
GUPTA: All right, and Dr. Arnow, you're a cardiologist, obviously, here, as well. Your first reaction when you heard about this polypill, this sort of combination medication to prevent heart disease. What were you thinking?
ARNOW: I think the study is very provocative. Frankly, I was excited when I heard about it. The idea that we could take everything but the kitchen sink and throw it into a single pill for patients, I think, has tremendous appeal for patients and for patients or for people who are at risk of developing disease. I think that I want everyone to realize at this point this is still an idea. It's an untested idea. And so I certainly am somewhat skeptical, since we don't really know whether the benefits would be realized and, if so, to what extent. And we also don't know whether the risks would be as low as the authors suggest.
Nevertheless, I think to take a serious look at this was well needed and I commend the authors on that.
OSBORN: Well, on this very topic we want to start...
WALD: Can I come in here?
OSBORN: ... answering some of your viewer phone calls. And right now we have on the line Janis from Knoxville.
Hello to you.
Welcome.
And your question for Dr. Gupta?
JANICE: Thank you for taking my call.
OSBORN: Sure.
JANICE: And I have a son that was 47 years old. He's had a slight heart attack and he has two stents in. One has been closed and they cannot open it. Would this help him at his stage?
GUPTA: OK, well, that's an interesting question. And actually Dr. Arnow, maybe to you, this is obviously somebody who already has existing heart disease. We'll get Dr. Wald to jump in. But first, Dr. Arnow, what do you say to someone like that?
ARNOW: Sure. First, I would say for people who have heart disease, most of the components of this pill have already been established to be beneficial, that is, we know aspirin, perhaps. Although we're not certain about folic acid, we know statens for certain, and we know in many people with heart disease blood pressure lowering medications are beneficial. So there's no question about that.
Your question, though, was specifically about someone who has a stent. That is a metal scaffold in one of their heart arteries and a stent that's now closed. Would this medication help?
These medications won't reopen the stent. If it's possible to do that, it would have to be done mechanically, that is, with something referred to as angioplasty. Sometimes, though, angioplasty isn't the right answer and the only way to fix that is surgery.
GUPTA: And Dr. Wald, obviously the question was about a patient who already has existing heart disease. Who is the target population for this polypill? Who's the most likely candidate to use this and benefit from it?
WALD: Well, two groups, people with existing heart disease. So this individual would benefit from this combination. But as Herb pointed out, it may not be sufficient because there is an additional problem that needs to be sorted out specifically and I can't clearly comment on that individual case.
But certainly anyone with existing cardiovascular disease would benefit, with diabetes mellitus and all adults from the age of 55.
I think I should point out that the evidence in support of the polypill and its components is based on many hundreds of trials and hundreds of thousands of patients. It's not a speculation or a hypothesis. It's based upon firm evidence. For three of the mechanisms that's lowering blood pressure, lowering cholesterol and reducing platelet stickiness, the evidence is cast iron. The evidence on folic acid for reducing homocystine is very strong, but not quite so solid.
But of all the components, that's the one that has the least effect. So I do think it's important that the public are aware that this is not a speculation. It is firmly based on evidence and the three papers in the British medical journal document that evidence.
OSBORN: Well, and as some of the doctors were referring to, there is an interesting question here. Even if there is a magic pill in our future, should we take steps today to reduce our risk of dying early?
We will look at the impact of food and exercise on our heart and take more of your calls and e-mails
GUPTA: And you can call us, as well, 800-807-2620 or fire off an e-mail, as Chris said. That's housecall@cnn.com. We're coming right back. Lots of discussion. Don't go away.
COMMERCIAL
GUPTA: You're watching CNN's "Weekend House Call."
Our topic today, your heart. And you may be at home wondering could you yourself be at risk of a heart attack? Well, if you're not sure, go to cnn.com/health. There you can read our story on the polypill. You can also click on a link to the American Heart Association, where if you answer just a few questions, you can determine your risk of having a heart attack in the next 10 years.
OSBORN: And if you are at home wondering, as the doctor said, we are taking your questions about your heart and how to keep it healthy today and in the future. You can call us right here, 800-807-2620. And before we go to the break, let's check our daily dose health quiz.
Listen to this one. Interesting question. How many people are diagnosed with heart disease in the U.S. every year? We'll have the answer in 30 seconds. Stay tuned for it.
COMMERCIAL
GUPTA: Welcome back to CNN our "Weekend House Call."
We've been talking about the polypill.
A couple of things. A lot of people are asking about potential side effects by combining all these different medications. Six different medications, again. Look at the list here -- liver problems possibly as a result of the staten medications; stomach irritation as a result of the aspirin and then dizziness, fatigue and headaches.
Well, besides keeping your fingers crossed that the polypill will save us all, there are things you can do, as well, to try and lower your risk of having a heart attack and heart disease. These are obvious ones. Everybody already knows these. Stop smoking, get more exercise, control stress, limit alcohol consumption and lower the fat in your diet.
Those are the knowns. We already know that.
Of course, that leads us to our next e-mail. A viewer from New Jersey writes, "I'd like to know if Americans in particular are more prone to heart disease than people residing in other countries as a result of our unhealthy food habits."
We talk a lot about that. Dr. Arnow is a cardiologist here in the United States.
What do you think about that, the idea that American citizens are a little bit more a target population here than other countries around the world?
ARNOW: I think it's fair to say that either sclerosis or plaque built up in the arteries affects everyone worldwide. But you're right that Americans, as a group, have higher rates. Whether that's our lifestyle or, in part, some of our genetics, it's hard to say. But I think a lot of it is the former, is what we do.
OSBORN: All right, we are now going to talk to Ed from Texas, who joins us on the phone with a question in this morning's "Weekend House Call" for Dr. Gupta.
Good morning to you, Ed.
ED: Good morning.
Thanks for taking my call.
OSBORN: It's a pleasure.
ED: As you said, the polypill is several years away. "Consumer Reports" last month had an article that suggested that natural fish oil concentrate in a dosage of about 1,000 milligrams a day would be beneficial for your entire cardiovascular system. I'd just like your reaction to that.
GUPTA: Well, that's an interesting question. And Dr. Wald, I'm going to throw this one over to you. Again, you mentioned the six components of this particular pill. What about fish oil? Was that something you considered?
WALD: Well, fish oil is generally regarded as beneficial. I'm not sure -- I mean the evidence needs to be firmed up quite a bit. And I'm not sure about the particular does that's been referred to. But in general, fish oils are regarded as a healthy form of nutrition.
GUPTA: OK.
OSBORN: Well, do you know the warning signs of a heart attack? We will talk about that very question and answer more of your phone calls and e-mail questions on this very significant health issue. That's coming up with Dr. Gupta right when we get back.
COMMERCIAL
GUPTA: Welcome back to "Weekend House Call."
We've spent some time this morning giving you some tips and strategies for a healthy heart. But what if you do have a heart attack? Would you know the warning signs? It's not always as it appears in the movies. It could just be some chest discomfort, pain in the arms, back or neck, shortness of breath, cold sweats or nausea.
We've been talking a lot about polypill this morning and we want to delve a little bit deeper into the issue again. Our guests, Dr. Nicholas Wald from London, Dr. Herb Arnow from Cleveland.
Just a couple of thoughts about this.
First of all, Dr. Wald, to you again, would this pill sort of get rid of the need to -- for people to live a healthy lifestyle? I think a lot of people are at home saying this is great. This pill is going to come out and when I turn 55 I just start popping this pill and I don't have to worry about all the other things that have been drilled into our heads for so many years.
WALD: No, it wouldn't. It's not an alternative to the avoidance of smoking and the control of weight. It's a complementary measure, preventive measure. And all it's really doing is applying the well recognized treatments for people who have already had a heart attack to people before they get it. So it's a form of primary prevention. It's using the same drugs to prevent the same events happening in the first place rather than just treating people who've already had an event.
OSBORN: So, Dr. Wald, Kris Osborn here. So I understand the intention or the idea is with this pill to take it in conjunction with doing other things that doctors such as yourself would recommend -- exercise, eating healthy, things like that.
WALD: Yes, reasonable exercise, reasonable diet. I mean what it would do is you don't have to be quite so obsessional over diet. You could have cheese from time to time. But you certainly should control your weight and one should certainly avoid smoking. So the measure, the polypill is in no way an alternative to these things. It's additional to them.
GUPTA: And Dr. Arnow, you've been a little bit skeptical, hearing your comments this morning. You know, when people talk about -- again, we talked about the fact that people know the right things to do to stay heart healthy and to avoid their risk, reduce their risks of certain diseases processes. Do you think a pill like this -- is it going to have a role? Or do we just need to focus on the fundamentals when it comes to our health?
ARNOW: Well, Sanjay, I think both are true. I think certainly we can't advocate pharmacotherapy, that is, medications, before we tell people to get off the couch and exercise, to eat right and to put the cigarettes down.
That being said, there are certainly people who despite doing all of those things will still need treatment and who may need medications and vitamins for prevention. That may be where the polypill comes into play. And I think in those higher risk populations it's certainly worth testing that idea. I'm just skeptical about using it as a blanket treatment for everyone over 55.
OSBORN: Well, let's bring Barb from Ontario into the conversation. She joins us now on the phone.
Good morning to you, Barb.
Glad you're on with us.
BARB: Good morning.
OSBORN: Sure. BARB: I would like to ask the doctors, I am currently on all those medications, with the exception of the cholesterol lowering and I just wondered if what I'm doing is the right thing now by taking everything on an individual basis.
GUPTA: Well, you know, this is an important point. Let me make a distinction really quick. On one hand, what the polypill is talking about is actually treating people before they get sick. What happens typically to most people is they wait till they -- people wait till they get sick before they start these medications.
Dr. Wald, what do you say to someone like this? She's already taking these medications.
WALD: Yes, I mean this is often the case, that one, during life, as one gets old enough, one winds up by taking many of the components. I would say that it's worth considering adding a staten because if you're on all the others, you must be judged to be at risk of cardiovascular disease and a staten is a very effective means of reducing your risk of a heart attack.
So by all means speak to your doctor and ask him whether he thinks you should go on the staten as well as the others.
GUPTA: And I should mention, as well, as part of the study that Dr. Wald conducted, he's saying, you know what? We would no longer need to do all these tests, we no longer need to get angiograms and all that sort of stuff for your heart. People would just start taking this pill at age 55, everybody would start taking it to try and prevent this thing. And it's obviously a very controversial subject.
We're going to get final thoughts from both doctors as well as myself when we come back in just a minute.
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GUPTA: Well, a very provocative show today on the polypill.
We want some final thoughts from both of our guests.
First, Dr. Nicholas Wald, the research on this topic.
He joins us from London.
Final thoughts, sir?
WALD: Io think three points. The expected impact is very great, preventing over 80 percent of heart attacks and strokes. Two, most heart attacks and strokes occur with people with about average cholesterol and blood pressure levels, so it's a mistake to just target those with raised levels. Everyone is at risk once they're old enough. And the last point is given that one can effectively prevent second events by treating people with disease, why not prevent first events by offering the treatment earlier?
GUPTA: Good point, sir. Thank you very much for joining us from London.
And Dr. Herb Arnow from Cleveland, a final thought, sir?
ARNOW: I also have three points, Sanjay.
The first is that everyone needs to eat right, exercise and stop smoking if they do. The second is that if you're at risk for, elevated risk for or already have cardiovascular disease, then the medications in the polypill may very well be right for you, at least alone. Whether they're right in combination remains to be seen. And finally, I think you need to see your doctor regularly for the detection and treatment of risk factors for cardiovascular disease. I don't think that putting people on a pill and on autopilot is the way to go.
GUPTA: All right, thank you both, gentlemen.
A very interesting show.
And CNN SATURDAY MORNING continues right now.
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