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.

Even as the US faces major outbreaks of Cyclospora and Salmonella infections, the Food and Drug Administration (FDA) has finalized safety guidance for operations handling ready-to-eat (RTE) fresh-cut produce.

The guidance incorporates public comments received on the October 2018 draft and replaces the FDA’s 2008 guidance on fresh-cut produce.

“This guidance represents the agency’s current thinking on the issues related to preventing contamination in fresh-cut produce,” the FDA said.

The agency also encouraged the industry to continue advancing food safety practices, including through best-practice documents tailored to specific commodities and processes.

The FDA’s guidance targets manufacturers and processors of fresh-cut produce and recommends measures such as sanitation controls, supplier verification and refrigeration amid ongoing outbreaks of cyclosporiasis and salmonella linked to fresh produce.

What Does the FDA Guidance Include?

The FDA recommendations are not legally binding and are aimed at manufacturers and processors of products such as chopped lettuce, sliced cantaloupe, diced onions, shredded carrots, coleslaw mixes and fruit salads.

Fresh-cut produce can include a single commodity, such as cut lettuce, sliced cantaloupe, diced celery, diced onions and shredded carrots, or combinations of two or more produce items, such as coleslaw mixes and fruit salads.

The FDA has focused on contamination with pathogens including salmonella, cyclospora, E. coli and listeria.

Fresh-cut produce processors should assess whether these pathogens pose potential hazards that require preventive measures, including supply-chain controls, the FDA said.

The recommended measures include:

• Using safe water
• Washing fruits and vegetables with antimicrobial solutions
• Training personnel
• Improving facility design
• Implementing sanitation controls
• Verifying suppliers
• Maintaining appropriate refrigeration

Why Is Fresh-Cut Produce at Risk?

Fresh-cut produce can be particularly susceptible to contamination because pathogens may be introduced at multiple points, including during growing, transportation, manufacturing, commingling with other products or at retail.

The opportunity for contamination can increase at each stage before the food reaches consumers.

Fresh-cut produce also does not undergo a kill step to eliminate pathogens that may be introduced during these processes, and most products are sold ready to eat.

The guidance provides recommendations and examples of how Preventive Controls for Human Food can be implemented to protect fresh-cut RTE produce from biological hazards.

Cyclospora and Salmonella Outbreaks

The guidance comes as the US investigates outbreaks linked to contaminated lettuce and jalapenos that have sickened thousands of people.

The cyclospora outbreak linked to iceberg lettuce from Taylor Farms has spread to 15 states, with Michigan hit the hardest.

“Americans should feel confident in eating fresh produce, including leafy greens at this point,” Diamantas said during an appearance on CNBC. The FDA said it remains confident that iceberg lettuce linked to the cyclospora outbreak had been effectively removed from the market following the July 17 recall.

The US Department of Health and Human Services also said Tuesday on X: “Cyclospora: contained, American food: safe.”

However, the FDA and CDC say the investigation into the cyclospora outbreak remains ongoing.

Separately, Taylor Farms said Monday that it was recalling prepared foods containing jalapenos from retailers in several states because of potential salmonella contamination.

Statins are widely used to lower “bad” LDL cholesterol and reduce the risk of heart attacks and strokes.

A new study published in The Lancet Healthy Longevity found that stopping statins in adults aged 75 and older with no history of cardiovascular disease did not increase the risk of death over three years compared with continuing treatment.

However, LDL cholesterol rose by around 50% among those who stopped taking the drugs.

Stopping Statins Did Not Increase Death Risk

The study found no significant difference in deaths or major cardiovascular events, including heart attacks and strokes, between older adults who stopped statins and those who continued treatment.

Researchers cautioned that the findings do not mean older adults should routinely stop taking statins.

“The decision to continue or stop statin treatment later in life should be individualized and made through shared decision-making between patients and clinicians,” the researchers said.

Further trials are needed to confirm the findings and assess the long-term effects of stopping statins.

“The benefits of statins increase over time in younger adults and it remains unknown whether stopping the medication could increase the risk of cardiovascular disease and death after the three-year follow-up period in older people,” said the researchers from Bordeaux University Hospital and Université de Bordeaux, France.

What Did the Trial Find?

The randomized controlled trial enrolled 1,160 adults aged 75 and older with no history of heart disease or stroke at general practices in France. Participants were randomly assigned to stop or continue their statin medication.

After three years:

• 7.2% (35/484) in the statin discontinuation group had died.
• 7.9% (48/604) in the continuation group had died.
• There was no significant difference in major cardiovascular events, including heart attacks and strokes.
• LDL cholesterol rose by 50%, from 115 mg/dL to 171 mg/dL, among those who stopped statins.
• LDL cholesterol showed no change among those who continued treatment.
• Physical and mental quality of life remained unchanged in both groups.

What Does This Mean for Patients?

The study involved people taking statins for primary prevention—those at risk of heart disease or stroke but without established cardiovascular disease.

The researchers stressed that the findings should not be interpreted as a recommendation to stop statins.

Instead, the decision should be based on the individual patient’s circumstances and discussed with a clinician.

Why Are Findings Important?

Evidence on the benefits of statins for primary prevention in older adults remains limited because many statin trials exclude people older than 70 or 80.

A 2013 Cochrane meta-analysis of 18 trials found a 14% reduction in deaths from all causes among adults taking statins for primary prevention of atherosclerotic cardiovascular disease. However, the median age of participants was 57.

The new findings also differ from observational studies from Denmark and Italy published in 2021. Those studies reported about a 30% higher risk of fatal and nonfatal cardiovascular outcomes after statins were discontinued in older adults.

Unlike those cohort studies, the new research was a randomized controlled trial, but it only followed participants for three years.

How Statins Work

Statins work by reducing the amount of cholesterol produced by the liver, helping slow the buildup of fatty plaque in the arteries.

They are prescribed both for people at risk of cardiovascular disease (primary prevention) and those with established cardiovascular disease (secondary prevention).

The new study does not establish that stopping statins is safe for all adults over 75. Longer-term research is needed to determine whether discontinuing treatment could affect cardiovascular risk or mortality beyond three years.

The U.S. Social Security Administration (SSA) has expanded its Compassionate Allowances (CAL) program by adding 14 serious and rare medical conditions, helping eligible patients to have their disability claims fast-tracked.

The announcement, made on August 11, brings the total number of conditions covered under the programme to 314. According to the SSA, more than 1.2 million people with severe disabilities have been approved through the fast-paced process since CAL was introduced.

Which Conditions Have Been Added To CAL?

The newly included conditions range from rare genetic and neurological disorders to aggressive cancers. They include:

• Aicardi Syndrome
• Baraitser-Winter Syndrome
• Bohring-Opitz Syndrome
• CASK-Related Gene Disorders
• Lafora Disease
• Warburg Micro Syndrome
• Hepatosplenic T-Cell Lymphoma
• Primary Cardiac Sarcoma
• Primary Intracranial Malignant Melanoma
• Metastatic Uveal Melanoma
• Malignant Migrating Partial Seizures of Infancy
• OPHN1 Syndrome
• Beare-Stevenson Cutis Gyrata Syndrome
• Adenylosuccinate Lyase Deficiency, neonatal form and Type 1

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What Is The Compassionate Allowances programme?

For people with severe disabilities, applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) can become another burden at a time when they are already dealing with a life-changing diagnosis.

The CAL programme, established in 2008, is designed to reduce the waiting time. When a person applies for disability benefits with a qualifying condition, the SSA can identify the diagnosis and move the claim through an accelerated determination process. In some cases, decisions can take days rather than months due to red tape.

The programme is particularly important for patients whose illnesses may prevent them from working while simultaneously creating significant medical and financial expenses.

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How Can This Expansion Help?

Rare diseases and aggressive cancers can progress rapidly, leaving patients and families with little financial breathing room. A conventional disability determination can involve gathering medical records and reviewing evidence before a decision is made.

“The Compassionate Allowances initiative cuts through red tape and allows us to deliver support to individuals who experience life-changing diagnoses and need help fast,” SSA Commissioner Frank J. Bisignano said.

The agency said it uses technology to identify potential CAL conditions and, where available, receives electronic medical records through its Health IT programme to help adjudicators make faster decisions.

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What Does This Change Mean For Patients?

The most important factor patients must note is that CAL is not a separate benefit or extra payment. It is a faster route through the existing SSDI and SSI disability determination process. Patients must still meet Social Security's definition of disability and other eligibility requirements.

There is also no separate CAL application. Patients should apply for SSDI or SSI and ensure their qualifying diagnosis is clearly documented. The SSA system can then flag eligible claims for accelerated processing of their claims.

For families facing rare, devastating diseases, that difference can be significant. Faster access to existing disability benefits can help bridge the gap between a diagnosis that changes someone's ability to work and the financial support they need to manage life after it.