NEWS from the Stroke Prevention Group of the World Stroke Organisation: WHO recommends the Polypill and advances of the HEARTS Partner Forum public health approach

07 Sep 2023

Recently, two major events have shown the progress of our prevention activities on a global scale.

Firstly, we report a major step forward in our campaign ‘Cut stroke in half’. The WHO announced on July 26 that the ‘polypill’ has been added to the World Health Organisation Model Lists of Essential Medicines (EML). Through this recommendation the polypill is now recommended as a drug for stroke prevention. It is acceptable as primary as well as for secondary stroke prevention. In a concerted action, led by the World Heart Federation, the WHO has accepted a fixed combination of preventative drugs condensed into one single pill (the polypill) as being effective and recommended its use. The combination of a fixed dose of antihypertensives (usually two or more), a cholesterol-lowering agent (usually a low dose statin), and in some cases nutrients such as Vitamins can be included. In secondary prevention of ischaemic stroke aspirin may be added. As the majority of strokes occur in middle- and low-income countries the use of the polypill can be given into the hands of the community health worker who also install prevention programs for the control of hypertension, diabetes and other stroke risk factors. Several trials, mostly run by the WHF (Valentin Fuster and Salim Yusuf), have shown its efficacy in the field. This has the potential to save millions of lives every year. One trial in Brazil, which focuses on stroke prevention is coordinated by the PI and WSO president Sheila Martins, is ongoing and the preliminary results will be reported at our World Stroke Congress in early October in Toronto, Canada.

With this landmark decision by the WHO, the WSO campaign ‘Cut Stroke in Half’ has reached its first major step. This campaign has been initiated several years ago by Michael Brainin, Valery Feigin, Jaakko Tuomilehto, Sheila Martins, and others, and has recommended the use of the polypill for stroke prevention. At the same time, this program recommends the control of medical and life-style risk factors. By applying risk factor control and use of the polypill in intermediate CVD risk persons together, it was calculated that the incidence of stroke can be reduced by one half world-wide. In the future therefore the WSO will push even harder for an uptake of a ‘polypill strategy’ and an increase of polypill production and distribution. Processes for accessibility, availability and affordability will be monitored together with community health worker activities in low- and middle-income countries.

Secondly, the WHO has partnered with the WSO and other organisations to increase the fight against hypertension on a global scale. This cooperation, the HEARTS Partner Forum, advances the public health approach to reduce cardiovascular disease morbidity and mortality.

Already in 2016, the World Health Organization (WHO) and the United States Centers for Disease Control (CDC) launched the Global Hearts initiative to support governments in strengthening the prevention and control of CVD.

HEARTS now contains the core technical package of the initiative and takes a public health approach to treating hypertension and other CVD risk factors at the primary health care level. The HEARTS Partner Forum [VF1] brings together 11 supporting partner organizations who are led by WHO and include, American Heart Association (AHA), Centre for Chronic Disease Control (CCDC), International Society of Hypertension (ISH), International Society of Nephrology (ISN), Pan American Health Organization (PAHO), Resolve to Save Lives (RTSL), US CDC, World Hypertension League (WHL), World Heart Federation (WHF) and World Stroke Organization (WSO).

By now, HEARTS has demonstrated the feasibility of a public health approach, with more than seven million people now on treatment for hypertension using a simple, algorithmic approach. Additionally, HEARTS has demonstrated the feasibility of using hypertension as a pathfinder to universal health coverage and should be a key intervention of all basic benefit packages. The partner forum continues to find ways to expand support and reinvigorate enthusiasm and attention on preventing CVD.

In this way, the HEARTS Partner Forum will mirror successful global partnerships on communicable diseases and assist countries in reducing CVD morbidity and mortality and achieving global WHO sustainable development goals.

https://pubmed.ncbi.nlm.nih.

Khan T et al, Front Public Health 2023; 11: 1146441

Brainin M et al. Polypill: Benefits seen for stroke and other outcomes. Stroke 2022; 53:2695-2701

Brainin M et al: Cut Strike in Half: Polypill for Primary Prevention of Stroke. Int J Stroke 2018: 13: 633-647

WHO Mode lLists of Essential Medicines 2023

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