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.

American drugmaker Eli Lilly’s first oral pill for weight loss, Orforglipron, marketed as Foundayo, has been given the green signal by the US Food and Drug Administration (FDA).

Lilly is also known for injectable drugs like Zepbound for obesity and Mounjaro and Trulicity for diabetes.

Foundayo’s approval comes after the US FDA in December last year approved Novo Nordisk’s Wegovy pill — the first-ever GLP-1 pill for weight loss. The Danish drugmaker rolled out the pill in January this year.

Novo Nordisk was also the first to launch oral GLP 1 Rybelsus to treat type 2 diabetes. It was approved by the US FDA in September 2019.

In a statement, the US FDA said that "Foundayo has been approved for use in combination with a reduced-calorie diet and increased physical activity. The pill is targeted to reduce excess body weight and maintain weight reduction for the long term in adults with obesity or overweight".

Lilly said that the drug will be available from April 6 through its its direct-to-consumer platform LillyDirect at a cost of $149 per month for the lowest dose for self-pay customers — on par with Novo's pill. "Shortly after” it will be available through retail pharmacies and telehealth providers in the US.

"Today, fewer than 1 in 10 people who could benefit from a GLP-1 are taking one, held back by access, stigma, perceived complexity, or the belief that their condition isn't serious enough for treatment. We believe Foundayo can help level the playing field for those living with obesity or who are overweight and living with weight-related complications," said David A. Ricks, chair and CEO of Eli Lilly and Company.

"As a convenient, once-daily oral pill that delivers meaningful weight loss, this is obesity care designed for the real world," he added.

Foundayo: A Meaningful Reduction In Body Weight

In these trials, 72 weeks of treatment with Foundayo, in combination with a reduced-calorie diet and increased physical activity, resulted in a statistically significant and clinically meaningful reduction in body weight.

Deborah Horn, Director of the Center for Obesity Medicine at McGovern Medical School at UTHealth Houston, stated that Foundayo “delivered an average of 12.4 percent weight loss at the highest dose in clinical trials – addressing both the clinical realities of obesity and the practical challenges patients face every day."

In addition, Foundayo also led to reductions in many markers of cardiovascular risk, including waist circumference, non-HDL cholesterol, triglycerides, and systolic blood pressure across all doses, Eli Lilly said.

How Foundayo Works

Lilly licensed Orforglipron, the main ingredient in Foundayo, from a Japanese pharmaceutical company in 2018.

As with the injectable forms of GLP-1s, Foundayo is available in six doses, ranging from 0.8mg to 17.2mg.

In consultation with their doctors, patients start with the lowest dose and gradually work up to higher doses; not everyone may need to reach the highest dose.

Also read: Eli Lilly's Experimental GLP-1 Pill Shows Promising Weight Loss

Unlike the Wegovy pill, people taking orforglipron do not need to restrict food or drink after taking the pill. Orforglipron is a small molecule that the body can absorb quickly and get into the blood, where it reaches the necessary tissues.

Foundayo: Side Effects

Foundayo is not safe for use in children and has an increased list of side effects, such as tumors in the thyroid, including thyroid cancer.

The drugmaker urged watching for possible symptoms, such as

• a lump or swelling in the neck,
• hoarseness,
• trouble swallowing
• shortness of breath.

• nausea,
• constipation,
• diarrhea,
• vomiting,
• indigestion,
• stomach (abdominal) pain,
• headache,
• swollen belly,
• feeling tired,
• belching,
• heartburn,
• gas,
• hair loss.

New Zealand has stepped up surveillance after the first detection of a dengue and Zika-carrying mosquito larvae in the country.

The larval species was confirmed as 'Aedes aegypti' — known to carry diseases including dengue fever, yellow fever, Zika, and chikungunya, across the globe.

As New Zealand does not normally have the mosquito species, the larvae detected were counted as "exotic".

The mosquito species did not cause any outbreak, but were spotted during a routine surveillance program in Auckland.

"The National Public Health Service has commenced a heightened surveillance and interception programme following mosquito larvae being collected from a routine surveillance trap at Queens Wharf, Auckland, on Monday 30 March," Health New Zealand said in a statement.

Health New Zealand reported that exotic species were occasionally found at ports and airports.

Not A Public Threat Yet

The health body noted that the larvae were not considered a public health or biosecurity threat yet because there was no indication they had become established.

But the agency aimed to continue "intensive monitoring for at least three weeks".

"The monitoring would take place within a 400m radius of the site where the larvae were identified. Health Protection Officers would place mosquito traps in the survey area," the statement said.

"These have been hidden away from plain sight so they are not disturbed, for example, in old tyres, bushes, or pools of water. We ask members of the public to avoid touching or disturbing these traps if they find them, as it may disrupt our monitoring and trapping efforts," medical officer of health Dr David Sinclair said.

Sinclair said New Zealanders were most at risk from diseases transmitted by mosquitoes when travelling overseas, including to Pacific Island countries and territories where dengue fever was known to be present.

Dengue Surging In 17 Countries

The US Centers for Disease Control and Prevention recently issued a travel alert of dengue outbreaks across 17 countries.

The CDC alert issued on March 23 identified 17 countries reporting an increased number of cases of dengue. These include: Afghanistan, Bangladesh, Bolivia, Colombia, Cook Islands, Cuba, Guyana, Maldives, Mali, Mauritania, New Caledonia, Pakistan, Samoa, Sudan, Timor-Leste, Vietnam, and the United States territories of American Samoa, Puerto Rico, and the US Virgin Islands, where local transmission is already common.

Also read: Long-term Exposure To Air Pollution Increases Fatality Rates In Dengue: Study

What Is Dengue?

Dengue is a disease caused by a virus spread through mosquito bites. It is transmitted through infected mosquitoes, primarily the species Aedes aegypti.

The breakbone fever is caused by an infection with any of four different dengue viruses. These include:

• Dengue virus type 1 (DENV-1 or DEN-1)

• Dengue virus type 2 (DENV-2 or DEN-2)

• Dengue virus type 3 (DENV-3 or DEN-3)

• Dengue virus type 4 (DENV-4 or DEN-4)

Also read: New dengue vaccine over 80% effective, prevents severe disease for up to 5 years

Common Symptoms of dengue include:

• Sudden onset of high-grade fever.

• Intense headache

• Severe muscle, joint, or bone pain.

• Skin Rash that often appears 2–5 days after the fever starts

• Nausea and Vomiting

• Minor bleeding

• Fatigue.

The COVID Cicada variant, currently circulating in 23 countries, is likely to affect children more than the previous variants.

Children have largely escaped severe illness from the SARS-COV-2 virus.

However, the new Cicada variant with around 75 genetic changes in its spike protein is likely to disproportionately affect children, as per an expert, who noted its presence in the UK.

“Some people have done analysis on this, suggesting it may be more prevalent among young children. Children get infections all the time, but this might be something to do with the fact that they have never been exposed to Covid vaccines," Prof Ravindra Gupta, of Cambridge University, who advised the UK government during the pandemic, was quoted as saying to The Mirror.

“So this is something we’re looking at in the lab to try and work out why. The problem with this is that it is an infection that spreads fast. Eventually, it ends up in someone vulnerable," he added.

Key Symptoms

Symptoms seem to be similar to those of other recent variants and include

• sore throat,
• cough,
• congestion,
• fatigue,
• headache
• fever.

Also read: Cicada Variant: Will The Current COVID Vaccine Provide Protection?

What Do The 75 Genetic Changes Mean?

Cicada, a descendant of the Omicron variant that emerged in 2021, was first detected in South Africa in 2024. However, it disappeared soon after, only to emerge early this year.

Prof Gupta told the publication that “the Cicada variant developed the 75 mutations to escape immunity, and it evolved by incubating a single patient for over a year”.

"This 'patient zero' would have been unable to clear the virus due to a compromised immune system," due to HIV or anti-cancer drugs.

Further, he explained that due to 75 mutations to the spike protein, the body’s antibodies will take a longer time to fight the Cicada variant.

However, there is no evidence yet that it is likely to cause more severe disease.

Will The Cicada Variant Cause Severe Illness?

The Cicada variant is particularly concerning as it provides no immune protection to people with previous infection or even vaccination.

Yet, the World Health Organization and health experts advise that existing COVID vaccinations can help prevent severe illness and hospitalization.

"It would appear that all the protections we have from our experience with the virus and with vaccines probably offer more limited—not zero—but more limited protection against this strain," Dr. William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center, was quoted as saying by Time.

Also read: COVID Variant BA.3.2 Spreads To 23 Countries: Is The Variant Under Monitoring A Cause Of Worry?

How To Safeguard

Dr. Sai Balasubramanian, a doctor and healthcare strategy executive, writing in Forbes, stressed the need to follow COVID practices such as masks and hand hygiene.

"Healthcare professionals recommend taking general precautions, similar to those used to prevent most viral transmission: get vaccinations when appropriate, wear masks in crowded areas or indoors where there is a high risk of transmission," he said.

He also urged “avoid individuals who have known illness or infections, wash hands frequently, and continue to stay apprised of local community guidelines and the infection spread”.