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.

In a groundbreaking move, the US Food and Drug Administration has approved the first-ever dual adeno-associated virus (AAV) vector-based gene therapy to treat hearing loss.

AAV-based gene therapy offers potential treatment for patients with OTOF gene-associated severe-to-profound hearing loss.

Developed by American Biotechnology company Regeneron, Otarmeni has been approved for the treatment of pediatric and adult patients with severe-to-profound and profound sensorineural hearing loss (any frequency more than 90 dB HL) associated with molecularly confirmed biallelic variants in the OTOF gene.

To date, no disease-modifying treatments exist for OTOF-related deafness.

“Today’s approval is a significant milestone in the treatment of genetic hearing loss,” said FDA Commissioner Marty Makary, in a statement.

“Through the national priority voucher pilot program, the agency is accelerating therapies for rare diseases with unmet medical needs while proving we can successfully review even the most complex submissions—such as novel dual vector gene therapies and combination products requiring coordination across multiple offices and centers—in significantly shortened timeframes,” Markary added.

Importantly, the company has announced that it will offer the therapy free of cost to qualifying individuals, at least during the initial rollout phase. The company cited its commitment to accessibility and patient impact as key reasons behind the decision.

How Otarmeni Works

Hearing loss affects over 430 million people worldwide, with a significant portion caused by genetic mutations. Genetic mutations cause about half of congenital hearing loss. Variants in the OTOF gene account for 2 per cent to 8 per cent of inherited, non-syndromic cases.

Until now, treatment options have largely been limited to hearing aids or cochlear implants, which assist hearing but do not address the underlying cause.

Genetic mutations cause about half of congenital hearing loss. Variants in the OTOF gene account for 2 per cent to 8 per cent of inherited, non-syndromic cases.

The OTOF gene is responsible for producing otoferlin, a protein essential for transmitting sound signals from the inner ear to the brain. Without it, sound cannot be processed, resulting in profound deafness.

Otarmeni is for patients with preserved outer hair cell function and no prior cochlear implant in the same ear.

Otarmeni includes a dual adeno-associated virus serotype 1 (AAV1) vector gene therapy administered as a single dose per ear surgically into the cochlea via a syringe and catheter provided in the Administration Kit and connected to an infusion pump.

The therapy delivers a functional copy of the OTOF gene to inner hair cells to restore otoferlin production and auditory signaling.

Are There Any Side Effects

The FDA noted that the common side effects included middle ear infection, nausea, dizziness, and procedural pain. Providers should monitor for surgical complications. It noted that the therapy is not recommended for patients with anatomy that prevents safe access to the inner ear.

The FDA approval comes after a landmark study, published in the New England Journal of Medicine, showed the benefits of hearing restoration. In trials, 80% of children aged 10 months to 16 years showed real improvement in just 24 weeks. This is not expected in the natural history of the disease without intervention.

For the past two days, Delhi locals have been waking up to extreme heatwave conditions. The India Meteorological Department (IMD) issued a warning of an extreme heatwave for Friday and Saturday, and we are now on day 2. On Friday, temperatures in the national capital were recorded at 43.1 degrees Celsius and 41.9 degrees Celsius. At the Ridge station and Lodhi Road, a high of 41.8 degrees was recorded, which met the criteria for heatwave conditions. Citing this, the IMD issued a yellow alert for Saturday, forecasting isolated heatwave conditions in the city. With this comes an increased risk of heat stress.

What is heat stress?

Heat stress refers to a state wherein the body absorbs more heat from the environment or produces heat through exertion that overwhelms the body's natural cooling system. This is caused by humidity, high temperatures, or exercise, leading to symptoms like headaches, dizziness, and, in extreme cases, heatstroke.

Heat stress occurs when the body is exposed to radiant heat, high air temperature, physical exertion, high humidity, or low air movement. It harms the body's ability to maintain a normal core temperature, thereby resulting in dehydration and cardiovascular strain. It is advised to wear protective clothing and drink plenty of water to stay hydrated.

What are the signs of heat stress?

Dr Anirban Chattopadhyay, Senior Consultant, Critical Care Medicine, CK Birla Hospitals, CMRI, in an interaction with Health and Me, spoke about the symptoms of heat stress. The expert said, “As the summer season begins and the sunlight is now scorching, heat and related symptoms increase. One of the early symptoms of heat exhaustion is headache, light-headedness, dizziness, and brain fog. This happens because the brain is temperature-sensitive. That is why patients often experience a headache when temperatures rise. This occurs due to vasoconstriction. One may experience dizziness and brain fog because the brain cannot withstand high levels of heat. These are the early symptoms of heat stress.”

When heat stress or prolonged heat exposure continues, it can progress to a more serious condition. This may even lead to a comatose state, known as heatstroke. Therefore, avoid direct sunlight exposure. If possible, stay indoors during peak hours, from 12 pm to 3 pm. Drink plenty of water to keep yourself hydrated, and consume electrolyte-containing fluids to maintain balance. When going out, use umbrellas and sunglasses, and wear breathable fabrics like cotton.

Heatwave across Central and North India

The heatwave is not restricted to the national capital—it is currently affecting northern and central states such as Madhya Pradesh, Rajasthan, Bihar, Chhattisgarh, Chandigarh, and Haryana. The conditions are likely to continue until April 27, with low chances of relief in the coming week.

World Malaria Day is observed on April 25 every year - on this day, experts spread awareness about malaria, an infection caused by the bite of the female Anopheles mosquito. Its symptoms include extremely high fever, headaches, chills, and fatigue. However, ahead of or during the monsoon season, people often get confused between viral fever and malaria due to similar symptoms. As a result, the infection is diagnosed late. On this occasion, Health and Me interacted with experts to learn more about the tests that one must take for malaria diagnosis.

An increase in the number of patients presenting at diagnostic centres with very high fevers has been attributed to people assuming they have a seasonal virus; however, when these patients present later, they often have life-threatening complications. According to the World Health Organization, over 280 million cases of viral infections worldwide were reported last year, making the clinical distinction between malaria and viral diseases increasingly deceptive.

Which tests to take for malaria diagnosis?

Dr Divya C, Microbiologist at Neuberg Anand Reference Laboratory, said, “Diagnostic testing has also transformed from the traditional microscope to more advanced diagnostic techniques, such as dual-target RDT (rapid diagnostic test), which detects HRP2 and Pf-LDH antigens. The RDT may not be able to detect some infections with lower numbers of malaria parasites circulating in the patient’s bloodstream. Therefore, all negative RDTs must be followed by microscopy to confirm the result.”

The expert went on to say that molecular PCR tests are now the preferred tests for cases with low parasite density or asymptomatic carriers, as they can detect fewer than 10 parasites per microlitre of blood with high levels of sensitivity. Some leading laboratories that perform PCR testing are also including AI-assisted digital microscopy as a supplement to the process, reducing human fatigue and providing significantly more precise results than a manual smear could.

What happens when malaria is diagnosed late?

The risk of “waiting to see” if malaria develops after the initial temperature spike is that, unlike most other viral fevers, malaria infects human red blood cells; the consequence of waiting can be organ failure or cerebral complications within 48–72 hours after the initial symptomatic temperature spike.

It is recommended that any patient with cyclic chills, excessive sweating, or fatigue should be tested based on differential diagnosis, as India moves towards becoming malaria-free by 2027. There is a short 15-minute diagnostic window to determine whether a patient can be treated without complications or is at risk of dying from malaria if it is missed.

Dr Praveen K Bharti (Scientist G), Director, ICMR–National Institute of Research in Tribal Health (NIRTH), Jabalpur, said, “We need testing to catch malaria early, but we also need the right kind of tests. Traditional tests often miss low-density, mixed, and asymptomatic infections. These are not minor gaps. As India advances towards its malaria elimination goals by 2030, point-of-care molecular tests for malaria diagnosis that can detect low-density, hidden reservoirs of infection will prove to be the key differentiator.”