Heart attacks and strokes are among the leading causes of death globally, with millions suffering from cardiovascular diseases (CVD) every year. There are more than seven million people in the UK alone, with about 100,000 patients experiencing heart attacks annually. However, a group of researchers at University College London (UCL) estimate that one 'polypill' taken daily day could eliminate a majority of these cases dramatically lowering death tolls.

The proposed polypill, a combination of a statin and three blood pressure-lowering drugs, has been under study for over two decades. Experts argue that introducing this pill universally for individuals aged 50 and above could be more effective than the current NHS Health Check, which assesses risk factors every five years for those aged between 40 and 74.

Studies have repeatedly proven the effectiveness of the polypill in preventing CVD. A groundbreaking 2019 study in The Lancet found that five years' use of the polypill cut the risk of heart attack and stroke by a third. In addition, previous modelling analyses have estimated that if given universally to people over 55, the polypill might be able to prevent 80% of heart attacks and strokes.

Today, the NHS Health Check follows a risk-based model in which patients are tested for CVD risk factors and treated with drugs accordingly. Yet, as per UCL's study, this system has serious flaws:

Low Uptake: Just 40% of those eligible for the NHS Health Check choose to have it, leaving a considerable number of at-risk patients undiagnosed and untreated.

Ineffective Prediction of Risk: The majority of heart attacks and strokes happen to people at average risk levels, thus making it challenging to identify the need for intervention effectively.

Limited Effectiveness: Even at maximum take-up, the NHS Health Check programme is predicted to have fewer health impacts compared to a polypill initiative applied to the whole population.

Simplicity and Affordability of the Polypill Strategy

One of the big benefits of the polypill is that it is so easy. In contrast to the existing screening-based model, the polypill scheme would not involve complicated medical tests or lengthy risk assessments. Instead, people reaching 50 would just have to fill out a few questions to determine possible side effects before they were prescribed.

Professor Aroon Hingorani of the UCL Institute of Cardiovascular Science, one of the strongest proponents of this scheme, says:

"Finally, the time is now to do much better on prevention. A population approach would prevent a lot more heart attacks and strokes than is done today with a strategy of trying to target a smaller group only."

Aside from the possible health implications, the polypill is also an economic solution. The drugs used are off-patent, thus cheap to produce and distribute. With the vast economic cost of managing CVD-related illnesses, a preventive model could result in substantial cost-saving for the NHS in the future.

The polypill has been proven to be effective by numerous international trials. In 2019, a randomised trial in rural Iran discovered that participants who took the polypill for five years had a 34% reduced risk of having a heart attack or stroke compared to non-participants.

Likewise, modelling research has indicated that even if only 8% of people aged over 50 took up the polypill regimen, it would still be more beneficial to their health than the NHS Health Check programme.

Is This a Case of Over-Medicalisation?

One of the main objections to the polypill strategy is the suggestion that it might result in the unnecessary medicalisation of a significant proportion of the population. But, it is argued, it should be considered as a preventative measure, not as mass medication.

Professor Sir Nicholas Wald of UCL's Institute of Health Informatics explains:

"Instead of being a 'medicalisation' of a significant proportion of the population, a polypill programme is a prevention measure to prevent an individual from becoming a patient."

He compares it with public health measures like water fluoridation or compulsory seatbelts—interventions that have been shown to have a significant impact in reducing public health danger at low individual cost.

With the evidence in favour of the polypill's effectiveness and viability overwhelming, experts are calling on the NHS to act now. It is their belief that substituting the NHS Health Check with a polypill-based prevention program could be the UK government's flagship policy under its pledge to put disease prevention ahead of cure.

As Professor Hingorani points out, "The status quo is not a justifiable option." With CVD still a major cause of death globally, taking a population-wide polypill approach could be a turning point for preventative medicine, potentially saving thousands of lives annually. The question now is whether the NHS will take up this call and establish a policy with the potential to transform the prevention of cardiovascular disease on a national level.

High levels of low-density lipoprotein cholesterol (LDL-C), commonly called "bad" cholesterol, continue to be a leading modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD) worldwide. While statins and other cholesterol-lowering medications have significantly improved treatment, many patients still do not reach the LDL-C targets recommended by guidelines.

However, a new potential solution has emerged. The experimental daily oral drug called enlicitide, part of the PCSK9 inhibitor class, demonstrated in a key Phase 3 study (CORALreef Lipids) a reduction in LDL-C of about 55.8% at 24 weeks, with post-hoc analysis suggesting reductions up to 59.7% compared to a placebo.

Statins Vs Enlicitide

Statins are the standard first-line treatment for high LDL-C and have strong evidence for lowering the risk of cardiovascular events. Yet, many patients either cannot tolerate high doses or still have elevated cholesterol levels. Injectable PCSK9 inhibitors, which are monoclonal antibodies, address this gap and can lower LDL-C by up to 70% but are expensive, require injections, and have limited uptake.

Introducing an oral PCSK9 inhibitor could make powerful LDL-C reduction more accessible. According to trial data, enlicitide may achieve reductions similar to injectable options while being more convenient and potentially more widely available.

Enlicitide: A Potential Breakthrough for "Bad" Cholesterol

The CORALreef Lipids Phase 3 study involved 2,912 adults at risk of or with established ASCVD who were either already on lipid-lowering therapy or unable to take statins. Participants were randomly assigned to receive a daily 20 mg dose of oral enlicitide or a placebo. At 24 weeks, the main analysis showed an average LDL-C reduction of 55.8%, with a post-hoc reanalysis estimating 59.7%. The drug’s safety profile was similar to placebo, with no major safety concerns reported and low rates of discontinuation due to adverse effects.

Enlicitide Implications: What Does This Mean Clinically?

These reductions are substantial, suggesting oral enlicitide could:

• Improve adherence since it eliminates the need for injections
• Increase access, particularly in resource-limited areas
• Provide an alternative for patients intolerant or resistant to statins

In India, where ASCVD prevalence is high and expensive therapies are less accessible, this pill could provide a practical, scalable option alongside diet, exercise, and current statin or ezetimibe treatments.

Enlicitide Caveats: Unanswered Questions To Be Mindful Of

Despite the promising LDL-C reductions, several key issues remain:

• Cardiovascular outcomes: It is not yet confirmed whether enlicitide lowers heart attacks, strokes, or mortality. Current data focus on cholesterol reduction, not clinical endpoints.
• Long-term safety: Data beyond 24 weeks and one year is limited.
• Approval and cost: Enlicitide is still investigational and not available for regular use. Regulatory approvals, like FDA evaluation, will review full data. Its real-world adoption in India will depend on cost and accessibility.
• Patient selection and combination therapy: How enlicitide will be integrated with existing statins, ezetimibe, and lifestyle interventions is still under review. Guidelines may require updating.
• Sub-group efficacy: Will results apply across different ethnicities, comorbidities, and specifically the Indian population? Local data will be important.

The investigational oral pill enlicitide could represent a major advance in cholesterol management. For patients whose LDL-C remains high despite statins, or who cannot tolerate injections, it offers a potent and convenient alternative. Yet, medicine requires caution.

Disclaimer: This content is for general informational purposes only and is not a substitute for professional medical advice. Always consult a doctor or specialist before starting or changing any medication

According to NHS advice, people who use gabapentin may face rare emergencies linked to the medicine. Although it is not officially classed as a painkiller, doctors often prescribe it for nerve pain that follows an injury. It is also used for discomfort caused by shingles or diabetes. The medicine works by interrupting pain signals that move between the brain and spinal cord. Gabapentin is also a common treatment for epilepsy and falls under the group of anticonvulsant drugs. Most people take it as capsules, tablets, or a liquid, usually three times a day.

NHS information notes that the majority of users do not face any side effects. Those who do usually notice only mild and short-lived symptoms.

What Is Gabapentin?

Gabapentin is a prescription drug that belongs to a group of medicines called anticonvulsants. Doctors usually give it to people who have nerve pain or to help manage certain types of seizures in epilepsy. It is sold under names like Neurontin, Gralise, and Horizant, along with widely used generic versions.

What Is Gabapentin Approved For?

Gabapentin is prescribed for a few main purposes:

• It helps prevent and control partial seizures. Adults and children aged three and older who experience partial seizures can take it as part of their treatment plan.
• It also eases nerve pain that can appear after a bout of shingles in adults. Shingles develops years after a person has had chickenpox. The chickenpox virus stays quiet in the dorsal root ganglion, a section of the spinal nerve. In some people, usually during times of heightened stress, the dormant virus becomes active again and causes the painful shingles rash. When the rash settles but the nerve pain remains, the condition is known as postherpetic neuralgia.
• Gabapentin is also approved for people who have moderate to severe primary restless legs syndrome.
• Neurontin and Gralise, the branded forms of gabapentin, are licensed for treating partial seizures and postherpetic neuralgia. Horizant, another branded version called gabapentin enacarbil, is approved for restless legs syndrome and postherpetic neuralgia.

Side Effects Of Gabapentin

There are times when gabapentin may lead to serious reactions that need emergency attention. Mild effects can include an upset stomach, dry mouth, weight gain, or slight memory troubles.

More concerning reactions may involve thoughts of self-harm, unusual muscle pain or weakness, or seeing or hearing things that are not there. Even then, NHS guidance states that these usually require an urgent call to a doctor or 111 rather than ambulance help.

When You Should Call 999 While Taking Gabapentin

Like many medicines, gabapentin can trigger a severe allergic reaction known as anaphylaxis. This can cause several symptoms, such as swelling in the throat or difficulty breathing. The NHS advises calling 999 if you are taking gabapentin and experience any of the following:

• Sudden swelling of the lips, mouth, tongue, or throat
• Fainting and the person cannot be woken
• Lips, skin, or tongue turning blue, pale, or grey
• Trouble breathing or unusually fast breathing
• A tight sensation in the throat or difficulty swallowing

Prostate Cancer Screening: A panel of government health experts in the UK has advised that routine prostate cancer screening should not be made available to most men, a decision that has drawn disappointment from several charities and campaigners.

The UK National Screening Committee (UKNSC) instead recommends targeted screening for men who carry a confirmed BRCA1 or BRCA2 gene mutation. These gene variants are linked to a higher risk of aggressive prostate cancers at a younger age. Men in this high-risk group could undergo screening every two years between ages 45 and 61.

The committee concluded that offering prostate cancer screening to all men—or even those with a family history—would do more harm than good. While it might slightly reduce the number of deaths from prostate cancer, it could result in extensive overdiagnosis.

Screening for black men, who are known to have a higher risk of developing prostate cancer, was not recommended due to insufficient and uncertain evidence.

Prostate Cancer Screening: Why UK Advisers Oppose Nationwide Screening

A major hurdle is the lack of strong evidence showing that mass prostate cancer screening significantly reduces deaths. The UK National Screening Committee (UKNSC) has determined that, at present, the potential harms of widespread testing outweigh the benefits, and therefore, a nationwide screening programme is not justified.

Health Secretary Wes Streeting said he would carefully review the draft recommendation, which will now undergo a 12-week consultation period before a final decision is presented to the government in March.

Prostate cancer remains the most common cancer among men, affecting one in eight, with around 55,300 new cases and 12,200 deaths each year in the UK. Despite being the second most common cancer overall after breast cancer, there is no routine screening program, partly because the PSA (prostate-specific antigen) test is not entirely reliable.

Prostate Cancer Targeted Screening Only for BRCA Gene Carriers

BRCA1 and BRCA2 are faulty genes that increase the risk of several cancers, including breast, pancreatic, ovarian, and prostate cancer. Around one in 300–400 people carries these mutations, and many are unaware of their status. Individuals with Jewish ancestry are at higher risk, with one in 40 Ashkenazi Jews and one in 140 Sephardi Jews carrying the faulty genes.

Men with a strong family history of cancer are encouraged to discuss blood or saliva testing with their GP. The proposed screening would likely only apply to a few thousand men due to the rarity of these gene mutations.

The UKNSC noted that screening black men or men with a family history of prostate cancer could result in significant overdiagnosis and overtreatment. Their modeling suggested that annual screening for black men aged 55–60 could lead to 44% of detected prostate cancers being overdiagnosed. Many of these cancers grow slowly and might never need treatment, but intervention could cause unnecessary anxiety and lifelong side effects, such as incontinence, erectile dysfunction, and bladder problems.

Chris Hoy Expresses Disappointment Over Screening Decision

Six-time Olympic gold medallist Sir Chris Hoy has shared his “disappointment and sadness” after learning that the UKNSC has not recommended population-level prostate cancer screening. Despite this setback, Hoy remains committed to using his platform to advocate for earlier detection of the disease.

Since his own diagnosis, Hoy has actively campaigned for better screening measures to catch prostate cancer sooner. Today’s decision by the UKNSC, however, has temporarily delayed those efforts.

Prostate Cancer Screening: Backlash From Charities and Public Figures

The committee’s decision has been met with mixed reactions. Cancer Research UK supported the cautious, evidence-based approach, noting that PSA testing can miss dangerous cancers and detect ones that do not require treatment. Prof Kamila Hawthorne, chair of the Royal College of GPs, also backed the committee’s decision, emphasizing that whole-population screening is not supported by current evidence.

However, charities like Prostate Cancer UK and Prostate Cancer Research, along with public figures including Stephen Fry and Prime Minister Rishi Sunak, expressed deep disappointment. They warned that excluding high-risk groups could lead to late diagnoses and preventable deaths.

Prostate Cancer Research criticized the exclusion of black men and those with family histories, calling it a “serious error” that could worsen health inequalities. Stephen Fry and Rishi Sunak both echoed disappointment, calling for broader screening. Former Prime Minister David Cameron also expressed concern, emphasizing the need for early detection to protect men and their families.

Health Secretary Wes Streeting reaffirmed that he wants evidence-backed screening and is committed to improving early detection and treatment for the most common cancers in men. He stated that progress is being made in reducing cancer waiting times, with 193,000 more patients diagnosed on time in the past year.