Cardiovascular diseases are the first cause of death worldwide. Recent decades have seen major advances in the diagnosis, treatment and prevention of these diseases. We now know that controlling risk factors, such as tobacco consumption, high blood pressure, diabetes, high levels of cholesterol or a lack of exercise, among other factors, reduce the probabilities of suffering from this disease.
But what happens after the onset of the disease? In these cases, a healthy lifestyle (no smoking, doing exercise, correct diet) can improve prognosis, but it is not enough on its own. We need preventive medication.
The drugs that improve life expectancy after a heart attack are well known: statins to reduce cholesterol, angiotensin-converting-enzyme (ACE) inhibitors, beta blockers and aspirin. The problem is they must be taken every day, which means the patient has to take a large number of pills.
Adhering to this therapy regime is not easy. Almost 50% of patients with chronic conditions do not take their medication in the correct way. There are many reasons that influence treatment adherence, but a major one is the complexity of the therapy. The higher the number of drugs, the lower the adherence.
Moreover, in some countries - generally low or medium income ones - the cost of secondary prevention medication is prohibitively high for most people. Consequently, this disease continues to spread throughout the world like an epidemic.
It was in 2006, after seeing with my own eyes the grave deficiencies in cardiovascular prevention due to the cost and scarcity of mediations in some emerging countries, that I had the idea for a polypill. It was not just a question of simplifying treatment, but of making it more accessible in these emerging countries.
Laboratorios Ferrer took up the challenge, and in September 2006 we began collaboration on an exciting project. Many meetings, consultations with national and international agencies, hours in the laboratory and clinical trials brought the final result: the polypill, a single pill that includes aspirin, an ACE inhibitor and a statin.
The polypill has been proven to reduce cardiovascular mortality 33% in patients treated after suffering a heart attack. The results of the SECURE study, published in The New England Journal of Medicine presented at the European Society of Cardiology Congress in Barcelona confirmed our suspicions: a polypill could become an integral part of strategies to prevent cardiovascular events in people who have suffered myocardial infarction. As treatment is simplified and adherence improves, this approach has the potential to reduce the risk of recurrent cardiovascular diseases and death.
Even more complex is the challenge of regenerating the heart, as this edition of CNIC Pulse thoroughly explains. Regeneration of the heart is currently one of the greatest challenges facing scientific investigation. At last year’s CNIC Conference 2022, over one hundred international experts spent two days debating the current possibilities that exist to overcome this scientific challenge, achieve regeneration of the human heart and prevent heart failure.
International experts, such as Dr. Elly Tanaka, Dr. Hesham Sadek and Dr. Mauro Giacca, among others, provided a critical insight into current controversies in the field of cardiac stem cells and other aspects like the failure, to date, of successfully translating experimental therapies into clinical benefits. The good news is that most of the speakers expect to see cardiac regeneration within their lifetimes.
This is also the work, for instance, of CNIC’s Molecular Genetics of Angiogenesis group, led by Dr. Rui Benedito, whose project “New approaches to heart tissue regeneration after heart attack” was selected by “la Caixa” Foundation for its Health Research Projects 2022, alongside another three CNIC projects.
