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.

An international team of researchers has identified a new way by which coronaviruses carried by bats can enter human cells.

Their study, published in the journal Nature, targeted the spike proteins of coronaviruses carried by heart-nosed bats in Kenya.

The team, including those from the universities of Cambridge and York, along with those from the National Museums of Kenya, found that a coronavirus, dubbed CcCoV-KY43, has evolved a new way of binding to human cells. It is different from the mechanism used by SARS-COV-2, the coronavirus responsible for the COVID-19 pandemic.

The virus - Cardioderma cor coronavirus (CcCoV) KY43, or CcCoV-KY43 - can bind to a receptor cell found in the human lung, but testing in Kenya suggests it has not spilled over into the local human population.

“Viral spike proteins are keys that fit into locks (host receptors) to open the door and enter a cell. So far, we have identified one alphaCov receptor. The challenge now is to find the others,” said Professor Stephen Graham in the Department of Pathology at the University of Cambridge, joint senior author of the paper.

CcCoV-KY43 is found in heart-nosed bats, Cardioderma cor, an ecologically important species found mainly in eastern Africa, including in eastern Sudan and northern Tanzania.

The researchers say the zoonotic (animal-to-human) and pandemic potential of alphaCoVs has remained relatively uncharted - to date, only two cellular receptors have been characterized for alphaCoVs.

Read: US CDC Study Showcasing COVID Vaccine Benefits Blocked From Publication

How Did The Researchers Identify The New Mechanism

Rather than work on ‘live’ viruses, the scientists used a public database of known genetic sequences, Genbank, to select and synthesise alphacoronavirus ‘spike’ proteins, including 27 viruses originally isolated in bats, and screened these against a library of coronavirus receptors found in human cells.

Spike proteins protrude from the surface of coronaviruses, including SARS-CoV-2, and bind to specific receptors on human cells, triggering infection.

They showed that CcCoV-KY43 binds to the human glycoprotein CEACAM6.

“Before our study, it was assumed all alphacoronaviruses used just one of two possible receptors to enter their host, and the only difference was which species they could enter. We now know alphaCovs might use a whole variety of different receptors to open cells,” said Dr Dalan Bailey, Group Leader at the Pirbright Institute and joint senior author of the paper.

“Not only did we find the new coronavirus receptor in human cells ahead of any virus spillover into the human population, but the study was performed using just a piece of the virus (the spike) rather than the whole pathogen, negating the need to import a live virus into the UK," added Dr Giulia Gallo, lead author of the paper.

Also read: Bangladesh Measles Outbreak: Meghalaya, Tripura To Ramp Up Vaccination, Boost Surveillance

The study stressed the need for further study in East Africa to better understand the risk from the family of viruses that can use this receptor to enter human cells.

This will help scientists to be better prepared for any spillover of the virus into humans in the future, and potentially begin to develop human vaccines and antivirals.

“We hope our findings will help better understand the risk from the family of viruses we identified that can use the human receptor: for example, by mapping the prevalence of the virus in bats and looking to see if it has already spilled over in at-risk populations,” Graham said.

The Bahamas joins 12 countries in the Region of the Americas, including Cuba and Brazil, certified as having eliminated the mother-to-child transmission of HIV, the World Health Organization (WHO) announced.

Eliminating mother-to-child HIV transmission, also called vertical transmission, to zero is a crucial milestone to achieve the UN-mandated Sustainable Development Goal to end AIDS by 2030.

The WHO has congratulated the country on its landmark achievement.

“I congratulate The Bahamas on this outstanding achievement, which solidifies years of political commitment and the dedication of health workers,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

“By ensuring that children are born free of HIV, we are securing a healthier, brighter future for the next generation,” he added.

What Is Mother-to-child Transmission Of HIV?

Mother-to-child transmission of HIV occurs when an HIV positive mother passes the virus to her child during pregnancy, labor, delivery, or breastfeeding.

In the absence of intervention, such a rate of transmission of HIV ranges from 15 per cent to 45 per cent. Globally, an estimated 1.3 million women and girls living with HIV become pregnant each year.

Read: Denmark 1st European country to eradicate mother-to-child transmission of HIV, syphilis

How The Bahamas Achieved Elimination

The Bahamas achieved the milestone by pioneering a comprehensive and inclusive health-care model. This includes public health measures such as:

The provision of universal antenatal care to all pregnant women, regardless of nationality or legal status, across both public and private facilities. a strong, integrated laboratory network

a rigorous testing protocol that screens women at their first antenatal appointment and again in the third trimester.

For the prevention and treatment of HIV and other sexually transmitted infections (STIs), the country has introduced pre-exposure prophylaxis (PrEP) for HIV prevention, which is also offered to pregnant women.

To ensure continuity of care, the health system maintains adequate monitoring for HIV-positive mothers and exposed infants, provides multi-month dispensing of antiretroviral medicines, and offers STI treatment and family planning services free of charge.

“HIV is a reportable condition in the Bahamas. And identifying women who tested positive is one of our first lines of defense for preventing mother-to-child transmission,” explained Glenise Johnson, epidemiologist with The Bahamas’ Ministry of Health and Wellness (MoHW).

Read: Reducing Mother-To-Child HIV Transmission To Zero Key To End AIDS In India: Experts

How Countries Achieve WHO certification

To meet the elimination criteria, countries must show that very few babies are born with HIV and that almost all pregnant women receive proper care. The countries must prove they have sustained the following:

• reducing the mother-to-child transmission rate of HIV to less than 2 per cent;
• achieving fewer than 5 new pediatric HIV infections per 1000 live births; and
• maintaining 95 per cent or higher coverage for antenatal care, HIV testing, and treatment for pregnant women.

"When women can test early in pregnancy, start treatment quickly, and stay in care, every child has a better chance of being born free of HIV and other STIs,” she added.

A new study published in the European Medical Journal recently found a link between seasonal changes in salt intake and chronic kidney disease risk. Furthermore, according to the study, seasonal changes in salt intake can influence blood pressure differently in men and women. However, it turns out that the effect is stronger in men during summer. For this, researchers followed 168 CKD patients for a year and analysed detailed daily urine collections to estimate salt intake, along with other clinical measurements. Researchers found that 147 patients had complete data for both winter and summer, which enabled a direct comparison of seasonal variations within the same individuals.

Seasonal patterns in blood pressure, salt intake

Consistent with previously existing knowledge, experts found that blood pressure was generally higher in winter than in summer. The study, however, found that salt intake had a similar seasonal pattern—its intake increased during winter. Male participants who had more salt in winter saw higher BMI, body weight, and blood pressure; meanwhile, cholinesterase and LDL were relatively lower. In female participants, there were fewer changes in the body as per the season—only blood pressure readings rose along with a few biochemical markers.

The most notable finding of the study came from regression analyses that examined the relationship between systolic blood pressure and salt intake. In men, there was a strong correlation where higher salt intake was linked to higher systolic BP. The association, however, was stronger during summer. Despite overall salt intake being lower in summer, the association was strong. In women, however, no such correlation was observed. In order to be certain about the potential effects of medication, researchers conducted another analysis of 90 people who were not taking drugs that may affect sodium excretion. The results were consistent, reinforcing the relevance of the findings.

Can this influence CKD management techniques?

Researchers suggested that gender-specific differences could influence diet and hypertension management strategies in kidney disease patients. The heightened sensitivity of systolic BP to salt intake in men during summer is an area of concern—while further research is required on the subject, it can still go a long way in the better management and treatment of chronic kidney disease.

How much salt can a CKD patient have safely?

According to experts, one must consume around 2,300 mg to maintain healthy blood pressure. However, for patients with CKD or high BP, 1,500 mg is more appropriate. Eating more salt than this in your daily diet can lead to water retention and blood pressure fluctuations. Over time, these can worsen heart health in the long run. Salt is 40 per cent sodium, and this component is found in high amounts in condiments like ketchup. It silently raises blood pressure and may even damage the kidneys.